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General NPI Number Information
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NPI Number | 1922671452
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Entity Type | Individual
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Provider Name | ALEXA BACINO RD, CDE
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Gender | Female
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Dates
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Enumeration Date | 07/22/2021
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Last Update Date | 02/01/2022
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Provider Practice Location Address
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Address Line | 75 E NORTHFIELD RD
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City | LIVINGSTON
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State | NJ
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Zip | 07039-4532
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Country | US
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Telephone | 908-516-9850
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Fax |
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Provider Business Mailing Address
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Address Line | 375 MOUNT PLEASANT AVE STE 105
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City | WEST ORANGE
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State | NJ
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Zip | 07052-2751
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Country | US
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Telephone | 973-322-6900
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Fax | 973-322-6996
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number |
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 86036487
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License Number State | NJ
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