MEDICARE: MRS. NATALIE Y ROBERTS-MOORE 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	930537	NJ

General Provider Information

NPI Number	:	1528264462
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. NATALIE Y ROBERTS-MOORE MS, RD

Provider Business Mailing Address
First Line	:	229 GOLDSMITH AVE
Second Line	:
City	:	NEWARK
State	:	NJ
Zip	:	07112-1718
Country	:	US
Telephone Number	:	973-230-0968
Fax Number	:

Provider Business Practice Location Address
First Line	:	108 S MUNN AVE
Second Line	:
City	:	EAST ORANGE
State	:	NJ
Zip	:	07018-3402
Country	:	US
Telephone Number	:	973-674-8100
Fax Number	:

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

Provider Enumeration Date	:	06/26/2007
Last Update Date	:	07/08/2007

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