Provider Demographics
NPI:1477688711
Name:BLUTE, ANDREA CARNEVALE (MS RDN CDCES)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:CARNEVALE
Last Name:BLUTE
Suffix:
Gender:F
Credentials:MS RDN CDCES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:223 N VAN DIEN AVE
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450-2736
Mailing Address - Country:US
Mailing Address - Phone:201-634-5371
Mailing Address - Fax:
Practice Address - Street 1:223 NORTH VAN DIEN AVENUE
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450-2736
Practice Address - Country:US
Practice Address - Phone:201-634-5354
Practice Address - Fax:201-634-5385
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
724515133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
P93676Medicare UPIN