Provider Demographics
NPI:1174404339
Name:ROITMAN, REBECCA PEARL (RD)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:PEARL
Last Name:ROITMAN
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 SPERIDAKIS TER
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02139-4017
Mailing Address - Country:US
Mailing Address - Phone:203-561-2750
Mailing Address - Fax:
Practice Address - Street 1:17 SPERIDAKIS TER
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02139-4017
Practice Address - Country:US
Practice Address - Phone:203-561-2750
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-11
Last Update Date:2025-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALDN6999133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered