=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376849117
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CYNTHIA L LOPEZ-PETTORINO RDN, CDCES
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/26/2011
-----------------------------------------------------
Last Update Date | 09/02/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 100 ENTERPRISE DR STE 301
-----------------------------------------------------
City | ROCKAWAY
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07866-2129
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-206-2130
-----------------------------------------------------
Fax | 973-385-1650
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | ROXBURY MALL 275 ROUTE 10 EAST, SUITE 220 (PMB#181)
-----------------------------------------------------
City | SUCCASUNNA
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07876
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-206-2130
-----------------------------------------------------
Fax | 973-385-1650
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 133V00000X
-----------------------------------------------------
Taxonomy Name | Registered Dietitian
-----------------------------------------------------
License Number | 848821
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------