Provider Demographics
NPI:1669527693
Name:KESSLER AXELROD, HERMINE (RD CDE)
Entity type:Individual
Prefix:MS
First Name:HERMINE
Middle Name:
Last Name:KESSLER AXELROD
Suffix:
Gender:F
Credentials:RD CDE
Other - Prefix:MS
Other - First Name:HERMINE
Other - Middle Name:
Other - Last Name:KESSLER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RD CDE
Mailing Address - Street 1:2100 LINWOOD AVE
Mailing Address - Street 2:SUITE 15D
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-3141
Mailing Address - Country:US
Mailing Address - Phone:201-461-9279
Mailing Address - Fax:201-461-8262
Practice Address - Street 1:2100 LINWOOD AVE
Practice Address - Street 2:SUITE 15D
Practice Address - City:FORT LEE
Practice Address - State:NJ
Practice Address - Zip Code:07024-3141
Practice Address - Country:US
Practice Address - Phone:201-461-9279
Practice Address - Fax:201-461-8262
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
00873077133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
22220261OtherCDE AM ASSOCIATION OF DIA
00873077OtherRD AM DIETETIC ASSOCIATIO