Provider Demographics
NPI:1720847858
Name:REALE, STEPHANIE (CNS)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:REALE
Suffix:
Gender:F
Credentials:CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 GARDEN ST APT 8A
Mailing Address - Street 2:
Mailing Address - City:HOBOKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07030-4497
Mailing Address - Country:US
Mailing Address - Phone:908-328-4029
Mailing Address - Fax:
Practice Address - Street 1:1500 GARDEN ST APT 8A
Practice Address - Street 2:
Practice Address - City:HOBOKEN
Practice Address - State:NJ
Practice Address - Zip Code:07030-4497
Practice Address - Country:US
Practice Address - Phone:908-328-4029
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-19
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist