Provider Demographics
NPI:1770807455
Name:RD4U INC
Entity type:Organization
Organization Name:RD4U INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:LAX
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:954-292-5625
Mailing Address - Street 1:2329 NE 18TH CT
Mailing Address - Street 2:
Mailing Address - City:JENSEN BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:34957-5125
Mailing Address - Country:US
Mailing Address - Phone:954-292-5625
Mailing Address - Fax:772-334-8781
Practice Address - Street 1:2329 NE 18TH CT
Practice Address - Street 2:
Practice Address - City:JENSEN BEACH
Practice Address - State:FL
Practice Address - Zip Code:34957-5125
Practice Address - Country:US
Practice Address - Phone:954-292-5625
Practice Address - Fax:772-334-8781
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-24
Last Update Date:2010-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND2293136A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes136A00000XDietary & Nutritional Service ProvidersDietetic Technician, RegisteredGroup - Single Specialty