Provider Demographics
NPI:1801432760
Name:CIUPPA, NICOLE (RDN)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:CIUPPA
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:84 LOTZ HILL RD
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07013-2313
Mailing Address - Country:US
Mailing Address - Phone:862-926-7722
Mailing Address - Fax:
Practice Address - Street 1:84 LOTZ HILL RD
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07013-2313
Practice Address - Country:US
Practice Address - Phone:862-926-7722
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-25
Last Update Date:2019-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ86088331133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered