Provider Demographics
NPI:1962776542
Name:MOSKOVITZ, LISA (RD, CDN, CPT)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:MOSKOVITZ
Suffix:
Gender:F
Credentials:RD, CDN, CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 EAST 35TH STREET, APT 1S
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-2805
Mailing Address - Country:US
Mailing Address - Phone:732-598-7221
Mailing Address - Fax:917-398-1344
Practice Address - Street 1:211 EAST 35TH STREET
Practice Address - Street 2:APT 1S
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-2805
Practice Address - Country:US
Practice Address - Phone:732-598-7221
Practice Address - Fax:917-398-1344
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-29
Last Update Date:2013-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007038133N00000X, 133V00000X, 133VN1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist
No133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic