Provider Demographics
NPI:1770097016
Name:MITOLA, ALYSSA (MS, RD, CEDRD, LD/N)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:MITOLA
Suffix:
Gender:F
Credentials:MS, RD, CEDRD, LD/N
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 HANOVER ROAD
Mailing Address - Street 2:BUILDING B SUITE 120
Mailing Address - City:FLORHAM PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07932-4082
Mailing Address - Country:US
Mailing Address - Phone:973-886-1230
Mailing Address - Fax:
Practice Address - Street 1:25 HANOVER ROAD
Practice Address - Street 2:BUILDING B SUITE 120
Practice Address - City:FLORHAM PARK
Practice Address - State:NJ
Practice Address - Zip Code:07932-4082
Practice Address - Country:US
Practice Address - Phone:973-886-1230
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-22
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND6980133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered