Provider Demographics
NPI:1508553124
Name:DISSEN, ANTHONY (RDN)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:
Last Name:DISSEN
Suffix:
Gender:M
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:139 BRICK BLVD APT 233
Mailing Address - Street 2:
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08723-7190
Mailing Address - Country:US
Mailing Address - Phone:856-371-8916
Mailing Address - Fax:
Practice Address - Street 1:139 BRICK BLVD APT 233
Practice Address - Street 2:
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08723-7190
Practice Address - Country:US
Practice Address - Phone:856-371-8916
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-24
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered