Provider Demographics
NPI:1902667157
Name:ISRAEL, ROBIN (RD, LD)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:
Last Name:ISRAEL
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 BROOKSIDE AVE STE 180
Mailing Address - Street 2:
Mailing Address - City:AMBLER
Mailing Address - State:PA
Mailing Address - Zip Code:19002-3436
Mailing Address - Country:US
Mailing Address - Phone:877-842-2425
Mailing Address - Fax:
Practice Address - Street 1:300 BROOKSIDE AVE STE 180
Practice Address - Street 2:
Practice Address - City:AMBLER
Practice Address - State:PA
Practice Address - Zip Code:19002-3436
Practice Address - Country:US
Practice Address - Phone:877-842-2425
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-16
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL12711133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered