Provider Demographics
NPI:1467712828
Name:NELSON, PERLA MIZRAHI (RDN)
Entity Type:Individual
Prefix:
First Name:PERLA
Middle Name:MIZRAHI
Last Name:NELSON
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 1:137 UNION BLVD
Mailing Address - Street 2:
Mailing Address - City:TOTOWA
Mailing Address - State:NJ
Mailing Address - Zip Code:07512-2767
Mailing Address - Country:US
Mailing Address - Phone:862-257-1297
Mailing Address - Fax:862-264-1964
Practice Address - Street 1:137 UNION BLVD
Practice Address - Street 2:
Practice Address - City:TOTOWA
Practice Address - State:NJ
Practice Address - Zip Code:07512-2767
Practice Address - Country:US
Practice Address - Phone:862-257-1297
Practice Address - Fax:862-257-1299
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-20
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ86023702133V00000X
NY35592907133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty