Provider Demographics
NPI:1528264462
Name:ROBERTS-MOORE, NATALIE Y (MS, RD)
Entity type:Individual
Prefix:MRS
First Name:NATALIE
Middle Name:Y
Last Name:ROBERTS-MOORE
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:229 GOLDSMITH AVE
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07112-1718
Mailing Address - Country:US
Mailing Address - Phone:973-230-0968
Mailing Address - Fax:
Practice Address - Street 1:108 S MUNN AVE
Practice Address - Street 2:
Practice Address - City:EAST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07018-3402
Practice Address - Country:US
Practice Address - Phone:973-674-8100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ930537133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered