Provider Demographics
NPI:1831261098
Name:AHMADI, AZADEH (MS, RD, CDN, CDE)
Entity type:Individual
Prefix:MISS
First Name:AZADEH
Middle Name:
Last Name:AHMADI
Suffix:
Gender:F
Credentials:MS, RD, CDN, CDE
Other - Prefix:MISS
Other - First Name:AZI
Other - Middle Name:
Other - Last Name:AHMADI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS, RD, CDN, CDE
Mailing Address - Street 1:53 PASSAIC AVE
Mailing Address - Street 2:
Mailing Address - City:PASSAIC
Mailing Address - State:NJ
Mailing Address - Zip Code:07055-4801
Mailing Address - Country:US
Mailing Address - Phone:973-745-4028
Mailing Address - Fax:973-471-6481
Practice Address - Street 1:53 PASSAIC AVE
Practice Address - Street 2:
Practice Address - City:PASSAIC
Practice Address - State:NJ
Practice Address - Zip Code:07055-4801
Practice Address - Country:US
Practice Address - Phone:973-745-4028
Practice Address - Fax:973-471-6481
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2012-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0004819133NN1002X, 133VN1004X, 133VN1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
No133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric
No133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ056596Medicare ID - Type UnspecifiedMEDICARE ID NUMBER