MEDICARE: MRS. DEENA ANISA NATALE RD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian

General Provider Information

NPI Number	:	1215906102
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DEENA ANISA NATALE RD

Provider Business Mailing Address
First Line	:	133 CHURCH ST
Second Line	:
City	:	LODI
State	:	NJ
Zip	:	07644-3322
Country	:	US
Telephone Number	:	973-246-6730
Fax Number	:	373-246-6730

Provider Business Practice Location Address
First Line	:	133 CHURCH ST
Second Line	:
City	:	LODI
State	:	NJ
Zip	:	07644-3322
Country	:	US
Telephone Number	:	973-246-6730
Fax Number	:	373-246-6730

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/14/2006
Last Update Date	:	07/08/2007

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