Provider Demographics
NPI:1730956657
Name:NIITZEL, REBECCA TONNESSEN (MSCN, RDN, CDN)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:TONNESSEN
Last Name:NIITZEL
Suffix:
Gender:F
Credentials:MSCN, RDN, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1440 CRESCENT DR
Mailing Address - Street 2:
Mailing Address - City:TARRYTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10591-5841
Mailing Address - Country:US
Mailing Address - Phone:908-894-0334
Mailing Address - Fax:
Practice Address - Street 1:1440 CRESCENT DR
Practice Address - Street 2:
Practice Address - City:TARRYTOWN
Practice Address - State:NY
Practice Address - Zip Code:10591-5841
Practice Address - Country:US
Practice Address - Phone:908-894-0334
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-11
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY86050915133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered