MEDICARE: ALINA DE ALMEIDA 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	1061134	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	450052429	OTHER		TAX ID
2	450052429	OTHER	NJ	450052429

General Provider Information

NPI Number	:	1356805501
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALINA DE ALMEIDA RD

Provider Business Mailing Address
First Line	:	35 S GLEN RD
Second Line	:
City	:	KINNELON
State	:	NJ
Zip	:	07405-2714
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	86 VALLEY RD
Second Line	:
City	:	MONTCLAIR
State	:	NJ
Zip	:	07042-2209
Country	:	US
Telephone Number	:	917-846-4644
Fax Number	:

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

Provider Enumeration Date	:	01/22/2019
Last Update Date	:	01/22/2019

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