Provider Demographics
NPI:1548724362
Name:MOSES, ELECTRA ARLENE (MS, RDN)
Entity type:Individual
Prefix:
First Name:ELECTRA
Middle Name:ARLENE
Last Name:MOSES
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 1:1802 STALLION CT
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08094-8745
Mailing Address - Country:US
Mailing Address - Phone:856-725-9408
Mailing Address - Fax:
Practice Address - Street 1:314 E MAIN ST STE 103
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19711-7180
Practice Address - Country:US
Practice Address - Phone:302-366-0550
Practice Address - Fax:302-366-8905
Is Sole Proprietor?:No
Enumeration Date:2019-01-25
Last Update Date:2019-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEPENDING133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered