Provider Demographics
NPI:1821823998
Name:ALDER, ABIGAIL LOUISE (MS, RDN)
Entity type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:LOUISE
Last Name:ALDER
Suffix:
Gender:F
Credentials:MS, RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 AVERY AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14216-1819
Mailing Address - Country:US
Mailing Address - Phone:315-857-7361
Mailing Address - Fax:
Practice Address - Street 1:29 AVERY AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14216-1819
Practice Address - Country:US
Practice Address - Phone:315-857-7361
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-06
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
86297983133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered