Provider Demographics
NPI:1508194382
Name:MARZANO, DANIELLE (REGISTERED DIETICIAN)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:MARZANO
Suffix:
Gender:F
Credentials:REGISTERED DIETICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PORT WASHINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11050-2917
Mailing Address - Country:US
Mailing Address - Phone:516-527-5955
Mailing Address - Fax:516-767-6349
Practice Address - Street 1:30 MAIN ST
Practice Address - Street 2:
Practice Address - City:PORT WASHINGTON
Practice Address - State:NY
Practice Address - Zip Code:11050-2917
Practice Address - Country:US
Practice Address - Phone:516-527-5955
Practice Address - Fax:516-767-6349
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-06
Last Update Date:2009-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY957603133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered