Provider Demographics
NPI:1922263508
Name:PINCUS, VIVIAN (RDCDE)
Entity Type:Individual
Prefix:MRS
First Name:VIVIAN
Middle Name:
Last Name:PINCUS
Suffix:
Gender:F
Credentials:RDCDE
Other - Prefix:MRS
Other - First Name:VIVIAN
Other - Middle Name:PINCUS
Other - Last Name:SERATA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RDCDE
Mailing Address - Street 1:38 TENAKILL ST
Mailing Address - Street 2:
Mailing Address - City:CLOSTER
Mailing Address - State:NJ
Mailing Address - Zip Code:07624-2507
Mailing Address - Country:US
Mailing Address - Phone:201-745-6690
Mailing Address - Fax:
Practice Address - Street 1:158 LINWOOD PLZ
Practice Address - Street 2:
Practice Address - City:FORT LEE
Practice Address - State:NJ
Practice Address - Zip Code:07024-3761
Practice Address - Country:US
Practice Address - Phone:201-461-0585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-23
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ816731133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ088740Medicare PIN