Provider Demographics
NPI:1780578112
Name:WEISER, KRISTINA (RD)
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:
Last Name:WEISER
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 1:801 MADISON ST APT 3I
Mailing Address - Street 2:
Mailing Address - City:HOBOKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07030-6445
Mailing Address - Country:US
Mailing Address - Phone:732-439-9184
Mailing Address - Fax:
Practice Address - Street 1:65 CROMWELL AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10304-3944
Practice Address - Country:US
Practice Address - Phone:718-667-8100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-09
Last Update Date:2025-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ86299281133V00000X
NY012789133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered