Provider Demographics
NPI:1558957993
Name:CORVINO, VALERIE KIM (RDN)
Entity Type:Individual
Prefix:
First Name:VALERIE
Middle Name:KIM
Last Name:CORVINO
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:137 W 15TH ST APT 4R
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-6730
Mailing Address - Country:US
Mailing Address - Phone:917-653-4854
Mailing Address - Fax:
Practice Address - Street 1:137 W 15TH ST APT 4R
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-6730
Practice Address - Country:US
Practice Address - Phone:917-653-4854
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-20
Last Update Date:2020-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY86074133OtherCOMMISSION ON DIETETIC REGISTRATION