Provider Demographics
NPI:1497900435
Name:VIOLANTE, JUSTINE MARIE (RD)
Entity Type:Individual
Prefix:
First Name:JUSTINE
Middle Name:MARIE
Last Name:VIOLANTE
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 E 54TH ST
Mailing Address - Street 2:APT 10K
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-4707
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:245 E 54TH ST
Practice Address - Street 2:APT 10K
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-4707
Practice Address - Country:US
Practice Address - Phone:732-547-7395
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-18
Last Update Date:2008-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY85007749133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered