Provider Demographics
NPI:1508545880
Name:LEBRON, IVETTE (REGISTERED DIETITIAN)
Entity Type:Individual
Prefix:
First Name:IVETTE
Middle Name:
Last Name:LEBRON
Suffix:
Gender:F
Credentials:REGISTERED DIETITIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 GETTY AVE
Mailing Address - Street 2:BUILDING 400
Mailing Address - City:PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07503
Mailing Address - Country:US
Mailing Address - Phone:347-839-7437
Mailing Address - Fax:
Practice Address - Street 1:11 GETTY AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07503
Practice Address - Country:US
Practice Address - Phone:973-754-2526
Practice Address - Fax:973-754-2628
Is Sole Proprietor?:No
Enumeration Date:2023-07-14
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ86144424133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered