Provider Demographics
NPI:1659156172
Name:NAIMOLI, MARTINE DERIVIERE (RDN)
Entity Type:Individual
Prefix:
First Name:MARTINE
Middle Name:DERIVIERE
Last Name:NAIMOLI
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 1:107 MIMOSA LN
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10312-1686
Mailing Address - Country:US
Mailing Address - Phone:718-227-2936
Mailing Address - Fax:
Practice Address - Street 1:107 MIMOSA LN
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10312-1686
Practice Address - Country:US
Practice Address - Phone:718-227-2936
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-31
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
86111395133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty