Provider Demographics
NPI:1629413703
Name:NEWMAN, ALEXIS M (RD, LDN)
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:M
Last Name:NEWMAN
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4258 PARKSIDE AVE
Mailing Address - Street 2:APT. 3
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-1098
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:399 MARKET ST STE 360
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19106-2138
Practice Address - Country:US
Practice Address - Phone:609-534-3008
Practice Address - Fax:855-370-1067
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-02
Last Update Date:2019-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN004100133N00000X
PA1010174133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist