Provider Demographics
NPI:1891277380
Name:ABISH, TARA ALIZA (RDN)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:ALIZA
Last Name:ABISH
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 1:79 CANARY DR
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-5453
Mailing Address - Country:US
Mailing Address - Phone:848-221-0353
Mailing Address - Fax:
Practice Address - Street 1:205 WYNATT ST
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-4839
Practice Address - Country:US
Practice Address - Phone:732-363-2010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-31
Last Update Date:2018-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ86087302133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered