Provider Demographics
NPI:1629585047
Name:LEE, RACHEL SOFI (RDN)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:SOFI
Last Name:LEE
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 1:101 OLD SHORT HILLS RD STE 211
Mailing Address - Street 2:
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-1023
Mailing Address - Country:US
Mailing Address - Phone:800-200-5553
Mailing Address - Fax:
Practice Address - Street 1:101 OLD SHORT HILLS RD STE 211
Practice Address - Street 2:
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052-1023
Practice Address - Country:US
Practice Address - Phone:800-200-5553
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-08
Last Update Date:2018-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ86072329133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered