Provider Demographics
NPI:1578843819
Name:GRIVAS, CHRISTINE M (RD)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:M
Last Name:GRIVAS
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 1:569 CLARENDON CT
Mailing Address - Street 2:
Mailing Address - City:RIVER EDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07661-2136
Mailing Address - Country:US
Mailing Address - Phone:551-574-8175
Mailing Address - Fax:
Practice Address - Street 1:730 PALISADE AVE
Practice Address - Street 2:1ST FLOOR
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-3144
Practice Address - Country:US
Practice Address - Phone:551-574-8175
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-18
Last Update Date:2011-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist