Provider Demographics
NPI:1740526581
Name:MASH, NICOLE BRIANA (MS, RD, CDN)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:BRIANA
Last Name:MASH
Suffix:
Gender:F
Credentials:MS, RD, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:743 PASSAIC AVE STE 449
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07012-1826
Mailing Address - Country:US
Mailing Address - Phone:607-972-1248
Mailing Address - Fax:
Practice Address - Street 1:743 PASSAIC AVE STE 449
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07012-1826
Practice Address - Country:US
Practice Address - Phone:607-972-1248
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-26
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007174133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered