Provider Demographics
NPI:1063035137
Name:MINOLFO, EVELYN (RDN)
Entity Type:Individual
Prefix:
First Name:EVELYN
Middle Name:
Last Name:MINOLFO
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 PEARL ST
Mailing Address - Street 2:
Mailing Address - City:NEW PROVIDENCE
Mailing Address - State:NJ
Mailing Address - Zip Code:07974-1010
Mailing Address - Country:US
Mailing Address - Phone:908-461-8196
Mailing Address - Fax:
Practice Address - Street 1:56 PEARL ST
Practice Address - Street 2:
Practice Address - City:NEW PROVIDENCE
Practice Address - State:NJ
Practice Address - Zip Code:07974-1010
Practice Address - Country:US
Practice Address - Phone:908-461-8196
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-24
Last Update Date:2020-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ994346133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered