MEDICARE: MS. CYNTHIA L LOPEZ-PETTORINO RDN, CDCES

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	848821	NJ

General Provider Information

NPI Number	:	1376849117
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CYNTHIA L LOPEZ-PETTORINO RDN, CDCES

Provider Business Mailing Address
First Line	:	100 ENTERPRISE DR STE 301
Second Line	:	ATTENTION: TEACHING FENIX RDN CAFE LLC
City	:	ROCKAWAY
State	:	NJ
Zip	:	07866-2129
Country	:	US
Telephone Number	:	973-206-2130
Fax Number	:	973-385-1650

Provider Business Practice Location Address
First Line	:	100 ENTERPRISE DR STE 301
Second Line	:
City	:	ROCKAWAY
State	:	NJ
Zip	:	07866-2129
Country	:	US
Telephone Number	:	973-206-2130
Fax Number	:	973-385-1650

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

Provider Enumeration Date	:	01/26/2011
Last Update Date	:	02/20/2024

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