Provider Demographics
NPI:1104193523
Name:NOVEMBRE-NOVOTNY, PAULETTE RITA (RD)
Entity Type:Individual
Prefix:MRS
First Name:PAULETTE
Middle Name:RITA
Last Name:NOVEMBRE-NOVOTNY
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ONE GUSTAVE L. LEVY PLACE MOUNT SINAI MEDICAL CENTER
Mailing Address - Street 2:NUTRITION DEPT. - BOX 1067
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-6574
Mailing Address - Country:US
Mailing Address - Phone:212-241-6198
Mailing Address - Fax:212-849-2588
Practice Address - Street 1:ONE GUSTAVE L. LEVY PLACE MOUNT SINAI MEDICAL CENTER
Practice Address - Street 2:NUTRITION DEPT. - BOX 1067
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-6574
Practice Address - Country:US
Practice Address - Phone:212-241-6198
Practice Address - Fax:212-849-2588
Is Sole Proprietor?:No
Enumeration Date:2011-11-30
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006009-1133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered