Provider Demographics
NPI:1710589593
Name:REAL FOOD REALISTIC
Entity type:Organization
Organization Name:REAL FOOD REALISTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN
Authorized Official - Prefix:MS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:JAMES
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RDN
Authorized Official - Phone:917-428-0544
Mailing Address - Street 1:7 KUHARS WAY
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18940-1337
Mailing Address - Country:US
Mailing Address - Phone:917-428-0544
Mailing Address - Fax:888-511-0373
Practice Address - Street 1:174 MIDDLETOWN BLVD STE 302
Practice Address - Street 2:
Practice Address - City:LANGHORNE
Practice Address - State:PA
Practice Address - Zip Code:19047-3201
Practice Address - Country:US
Practice Address - Phone:917-428-0544
Practice Address - Fax:888-511-0373
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-16
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty