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General NPI Number Information
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NPI Number | 1821579913
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Entity Type | Organization
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Legal Business Name | RD OF NEPA LLC
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Dates
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Enumeration Date | 08/27/2018
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Last Update Date | 09/08/2022
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Provider Practice Location Address
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Address Line | 532 MAIN ST STE 3
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City | MOOSIC
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State | PA
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Zip | 18507-1001
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Country | US
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Telephone | 570-457-2464
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Fax | 570-457-2492
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Provider Business Mailing Address
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Address Line | 532 MAIN ST STE 3
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City | MOOSIC
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State | PA
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Zip | 18507-1001
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Country | US
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Telephone | 570-457-2464
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Fax | 570-457-2492
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Authorized Official
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Title or Position | OWNER
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Name | LEANNA TABATABAIE
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Credential | MS, RDN
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Telephone | 570-457-2464
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State | PA
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