Provider Demographics
NPI:1356136097
Name:ADLER, TAYLOR TRACE (RDN)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:TRACE
Last Name:ADLER
Suffix:
Gender:
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3097 RALPH AVE
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11572-4420
Mailing Address - Country:US
Mailing Address - Phone:516-776-1729
Mailing Address - Fax:
Practice Address - Street 1:3097 RALPH AVE
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:NY
Practice Address - Zip Code:11572-4420
Practice Address - Country:US
Practice Address - Phone:516-776-1729
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-12
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY86303864133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered