Provider Demographics
NPI:1689363699
Name:ASSADOURIAN, ALINE
Entity Type:Individual
Prefix:
First Name:ALINE
Middle Name:
Last Name:ASSADOURIAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 PIERMONT AVE
Mailing Address - Street 2:
Mailing Address - City:HILLSDALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07642-2222
Mailing Address - Country:US
Mailing Address - Phone:201-903-5316
Mailing Address - Fax:
Practice Address - Street 1:1608 LEMOINE AVE STE 203
Practice Address - Street 2:
Practice Address - City:FORT LEE
Practice Address - State:NJ
Practice Address - Zip Code:07024-5636
Practice Address - Country:US
Practice Address - Phone:201-903-5316
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-04
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ86343415133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered