Provider Demographics
NPI:1205609294
Name:BERLANT, ALYSE MARIE (RD)
Entity type:Individual
Prefix:
First Name:ALYSE
Middle Name:MARIE
Last Name:BERLANT
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:ALYSE
Other - Middle Name:MARIE
Other - Last Name:VAN LIEW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:2333 FAIRMOUNT AVE APT 309
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19130-2547
Mailing Address - Country:US
Mailing Address - Phone:908-868-7321
Mailing Address - Fax:
Practice Address - Street 1:2333 FAIRMOUNT AVE APT 309
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19130-2547
Practice Address - Country:US
Practice Address - Phone:908-868-7321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-01
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN008113133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered