Provider Demographics
NPI:1073875068
Name:MODY, PAYAL (RD, CNSC)
Entity Type:Individual
Prefix:MRS
First Name:PAYAL
Middle Name:
Last Name:MODY
Suffix:
Gender:F
Credentials:RD, CNSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1117 BIRCHWOOD CT
Mailing Address - Street 2:
Mailing Address - City:NORTH BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08902-1924
Mailing Address - Country:US
Mailing Address - Phone:732-991-0775
Mailing Address - Fax:
Practice Address - Street 1:1117 BIRCHWOOD CT
Practice Address - Street 2:
Practice Address - City:NORTH BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08902-1924
Practice Address - Country:US
Practice Address - Phone:732-991-0775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-14
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL953243133V00000X
MD1858150133VN1006X
NJ133VN1004X133VN1004X
NJ133VN1005X133VN1005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic
No133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric
No133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal