Basic Information
| Provider Information | |||||||||
| NPI: | 1235763202 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LINDA HEISER RDN LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4-54 BOYD AVE | ||||||||
| Address2: | |||||||||
| City: | FAIR LAWN | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 074102143 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2019784358 | ||||||||
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| Practice Location | |||||||||
| Address1: | 401 HAMBURG TPKE STE 302 | ||||||||
| Address2: | |||||||||
| City: | WAYNE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 074702139 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9737909222 | ||||||||
| FaxNumber: | 9737900671 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/27/2020 | ||||||||
| LastUpdateDate: | 02/27/2020 | ||||||||
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| AuthorizedOfficialLastName: | HEISER | ||||||||
| AuthorizedOfficialFirstName: | LINDA | ||||||||
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| AuthorizedOfficialTitleorPosition: | REGISTERED DIETITIAN NUTRITIONIST | ||||||||
| AuthorizedOfficialTelephone: | 2019784358 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | RDN | ||||||||
| NPICertificationDate: | 02/27/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.