Provider Demographics
NPI:1699223750
Name:MEIRA WALDMAN RD LLC
Entity type:Organization
Organization Name:MEIRA WALDMAN RD LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:KP OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MEIRA
Authorized Official - Middle Name:RAIZEL
Authorized Official - Last Name:WALDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:732-534-0610
Mailing Address - Street 1:205 WYNATT STREET
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-4839
Mailing Address - Country:US
Mailing Address - Phone:732-534-0610
Mailing Address - Fax:848-373-9499
Practice Address - Street 1:205 WYNATT STREET
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-4839
Practice Address - Country:US
Practice Address - Phone:732-534-0610
Practice Address - Fax:848-373-9499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-19
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Multi-Specialty
No133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1699223750Medicaid