Provider Demographics
NPI:1174916126
Name:MORIARTY, ALEXA MCDONALD (MS, RD)
Entity type:Individual
Prefix:MS
First Name:ALEXA
Middle Name:MCDONALD
Last Name:MORIARTY
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:ALEXA
Other - Middle Name:
Other - Last Name:MCDONALD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:738 MARCELLUS DR
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07090-2013
Mailing Address - Country:US
Mailing Address - Phone:610-505-3566
Mailing Address - Fax:
Practice Address - Street 1:738 MARCELLUS DR
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07090
Practice Address - Country:US
Practice Address - Phone:201-653-6036
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-16
Last Update Date:2018-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY48 007690133V00000X
01024127133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered