Provider Demographics
NPI:1750317707
Name:DINZES, ELYSA FAITH (RD)
Entity Type:Individual
Prefix:MRS
First Name:ELYSA
Middle Name:FAITH
Last Name:DINZES
Suffix:
Gender:F
Credentials:RD
Other - Prefix:MS
Other - First Name:ELYSA
Other - Middle Name:FAITH
Other - Last Name:SILBERSMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:76 N HILLSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039-1110
Mailing Address - Country:US
Mailing Address - Phone:917-837-0598
Mailing Address - Fax:
Practice Address - Street 1:66 W MOUNT PLEASANT AVE STE 205
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039-2930
Practice Address - Country:US
Practice Address - Phone:917-837-0598
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-23
Last Update Date:2020-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005725133V00000X
931147133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY9133E1Medicare PIN