Provider Demographics
NPI:1013791466
Name:SMALL, ALYSON JILL (REGISTERED DIEITIAN)
Entity Type:Individual
Prefix:
First Name:ALYSON
Middle Name:JILL
Last Name:SMALL
Suffix:
Gender:F
Credentials:REGISTERED DIEITIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 FOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-4403
Mailing Address - Country:US
Mailing Address - Phone:201-572-0597
Mailing Address - Fax:
Practice Address - Street 1:230 FOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-4403
Practice Address - Country:US
Practice Address - Phone:201-572-0597
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-24
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ888750133V00000X, 133VN1201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1201XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Obesity and Weight Management
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered