Provider Demographics
NPI:1518684141
Name:LERITZ, ALEXANDER (RDN/RD)
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:
Last Name:LERITZ
Suffix:
Gender:M
Credentials:RDN/RD
Other - Prefix:
Other - First Name:ALEXANDER
Other - Middle Name:
Other - Last Name:SALISBURY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDN/RD
Mailing Address - Street 1:1213 W WATER ST APT B
Mailing Address - Street 2:
Mailing Address - City:ELMIRA
Mailing Address - State:NY
Mailing Address - Zip Code:14905-2025
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:600 ROE AVE STE 1G
Practice Address - Street 2:
Practice Address - City:ELMIRA
Practice Address - State:NY
Practice Address - Zip Code:14905-1629
Practice Address - Country:US
Practice Address - Phone:607-795-2820
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-25
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY86197597133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty