Provider Demographics
NPI:1295579084
Name:COSLIT, CARISSA (MS, RD)
Entity type:Individual
Prefix:
First Name:CARISSA
Middle Name:
Last Name:COSLIT
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:CARISSA
Other - Middle Name:
Other - Last Name:SEIDENFRAU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:33-41 NEWARK ST FL 5
Mailing Address - Street 2:
Mailing Address - City:HOBOKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07030-5627
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:21 LEIF BLVD
Practice Address - Street 2:
Practice Address - City:CONGERS
Practice Address - State:NY
Practice Address - Zip Code:10920-1309
Practice Address - Country:US
Practice Address - Phone:914-646-0791
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-25
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY86389842133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered