Provider Demographics
NPI:1609556315
Name:VINOKUROV, PATRICIA (MS, RDN, LDN)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:VINOKUROV
Suffix:
Gender:F
Credentials:MS, RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1509 CRANBERRY DR
Mailing Address - Street 2:
Mailing Address - City:WEST NORRITON
Mailing Address - State:PA
Mailing Address - Zip Code:19403-5142
Mailing Address - Country:US
Mailing Address - Phone:215-813-5608
Mailing Address - Fax:
Practice Address - Street 1:4400 US 9
Practice Address - Street 2:
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-1383
Practice Address - Country:US
Practice Address - Phone:732-589-2547
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-19
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA86314445133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered