Provider Demographics
NPI:1366617276
Name:BAKSHIYEV, REGINA (RD, CDN)
Entity type:Individual
Prefix:MRS
First Name:REGINA
Middle Name:
Last Name:BAKSHIYEV
Suffix:
Gender:F
Credentials:RD, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 MCGUIRE CT
Mailing Address - Street 2:
Mailing Address - City:OLD BRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:08857-4400
Mailing Address - Country:US
Mailing Address - Phone:732-910-5862
Mailing Address - Fax:
Practice Address - Street 1:13-51 RIVER RD STE B
Practice Address - Street 2:
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410
Practice Address - Country:US
Practice Address - Phone:201-398-0020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-23
Last Update Date:2018-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ984541133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY006657-1OtherTHE UNIVERSITY OF THE STATE OF NEW YORK, OFFICE OF THE PROFESSIONS