MEDICARE: LAURA STAGLIANO MS, 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	1010716	NJ

General Provider Information

NPI Number	:	1417317520
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA STAGLIANO MS, RD

Provider Business Mailing Address
First Line	:	350 SPRINGFIELD AVE STE 200
Second Line	:
City	:	SUMMIT
State	:	NJ
Zip	:	07901-4610
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	350 SPRINGFIELD AVE STE 200
Second Line	:
City	:	SUMMIT
State	:	NJ
Zip	:	07901-4610
Country	:	US
Telephone Number	:	973-544-8742
Fax Number	:

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

Provider Enumeration Date	:	03/02/2016
Last Update Date	:	03/03/2025

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