Provider Demographics
NPI:1326330465
Name:ISENBERG, SHIRA (RD, MPH)
Entity Type:Individual
Prefix:
First Name:SHIRA
Middle Name:
Last Name:ISENBERG
Suffix:
Gender:F
Credentials:RD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 TENNYSON PL
Mailing Address - Street 2:APT. B
Mailing Address - City:PASSAIC
Mailing Address - State:NJ
Mailing Address - Zip Code:07055-4514
Mailing Address - Country:US
Mailing Address - Phone:973-470-5719
Mailing Address - Fax:
Practice Address - Street 1:14 TENNYSON PL
Practice Address - Street 2:APT. B
Practice Address - City:PASSAIC
Practice Address - State:NJ
Practice Address - Zip Code:07055-4514
Practice Address - Country:US
Practice Address - Phone:973-470-5719
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-09
Last Update Date:2011-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered