Provider Demographics
NPI:1790157840
Name:ALYSON FLAKER, RDN LLC
Entity Type:Organization
Organization Name:ALYSON FLAKER, RDN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN
Authorized Official - Prefix:MS
Authorized Official - First Name:ALYSON
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:FLAKER
Authorized Official - Suffix:
Authorized Official - Credentials:RDN
Authorized Official - Phone:862-377-5445
Mailing Address - Street 1:43 BAMFORD AVE
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07506-2902
Mailing Address - Country:US
Mailing Address - Phone:862-377-5445
Mailing Address - Fax:
Practice Address - Street 1:92 SUMMIT AVE
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-1263
Practice Address - Country:US
Practice Address - Phone:862-955-0594
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-28
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service