Nicole Lynne Kizitaff, RDN

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

1019387 Issued in NJ

Practice address

126 Davis Ave
Mount Ephraim, NJ 08059-1614

Phone

(856) 655-8182

NPI assigned

Mar 5, 2012

Last updated

Mar 17, 2018By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1330905600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1750655007",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "126 DAVIS AVE",
            "city": "MOUNT EPHRAIM",
            "state": "NJ",
            "postal_code": "080591614",
            "telephone_number": "856-655-8182"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "126 DAVIS AVE",
            "city": "MOUNT EPHRAIM",
            "state": "NJ",
            "postal_code": "080591614",
            "telephone_number": "856-655-8182"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1930 S Broad St",
            "address_purpose": "LOCATION",
            "city": "Philadelphia",
            "state": "PA",
            "postal_code": "191452328",
            "country_code": "US",
            "telephone_number": "215-339-4563",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KIZITAFF",
        "first_name": "NICOLE",
        "middle_name": "LYNNE",
        "credential": "RDN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-03-05",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "PA",
            "license": "1019387",
            "primary": false
        },
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "NJ",
            "license": "1019387",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bernard Jacobs, DDS
• Caitlin M Johnson
• Jaclyn M Kenney
• Marie Kim, DMD
• Sunghun Kim, DMD
• Renato Richard Latini, D.D.S.
• Shikeena Lynard, LAC
• Paige Mason, LCSW
• Ashley Matousek
• Medexpress Urgent Care - New Jersey, Inc (MedExpress Urgent Care - Mount Ephraim)

• Registered Dietitian in Mount Ephraim, NJ
• Providers in Mount Ephraim, NJ by specialty
• Registered Dietitian in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.