Provider Demographics
NPI:1518664952
Name:MARZIGLIANO, ANGELIQUE (BS, MSACN, CNS)
Entity Type:Individual
Prefix:MISS
First Name:ANGELIQUE
Middle Name:
Last Name:MARZIGLIANO
Suffix:
Gender:F
Credentials:BS, MSACN, CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:417 LAKE AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT JAMES
Mailing Address - State:NY
Mailing Address - Zip Code:11780-2207
Mailing Address - Country:US
Mailing Address - Phone:631-769-5356
Mailing Address - Fax:
Practice Address - Street 1:417 LAKE AVE
Practice Address - Street 2:
Practice Address - City:SAINT JAMES
Practice Address - State:NY
Practice Address - Zip Code:11780-2207
Practice Address - Country:US
Practice Address - Phone:631-769-5356
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-15
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY17630133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist