Provider Demographics
NPI:1326888454
Name:ALYSSA MITOLA RD
Entity type:Organization
Organization Name:ALYSSA MITOLA RD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALYSSA
Authorized Official - Middle Name:
Authorized Official - Last Name:MITOLA
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RD, CEDS-C
Authorized Official - Phone:973-886-1230
Mailing Address - Street 1:25 HANOVER ROAD
Mailing Address - Street 2:BUILDING B SUITE 120
Mailing Address - City:FLORHAM PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07932
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:25 HANOVER ROAD
Practice Address - Street 2:BUILDING B SUITE 120
Practice Address - City:FLORHAM PARK
Practice Address - State:NJ
Practice Address - Zip Code:07932
Practice Address - Country:US
Practice Address - Phone:973-886-1230
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-28
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty