Provider Demographics
NPI:1003412644
Name:PERNICE, ALYSSA (RDN)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:PERNICE
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 AUSTIN CT
Mailing Address - Street 2:
Mailing Address - City:DEPTFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08096-5113
Mailing Address - Country:US
Mailing Address - Phone:856-296-3284
Mailing Address - Fax:
Practice Address - Street 1:115 AUSTIN CT
Practice Address - Street 2:
Practice Address - City:DEPTFORD
Practice Address - State:NJ
Practice Address - Zip Code:08096-5113
Practice Address - Country:US
Practice Address - Phone:856-296-3284
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-09
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ86108634133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty