Provider Demographics
NPI:1659597557
Name:GRIMALDI, ELIZABETH A (RD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:A
Last Name:GRIMALDI
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 1:6 OAK LN
Mailing Address - Street 2:
Mailing Address - City:CAMPBELL HALL
Mailing Address - State:NY
Mailing Address - Zip Code:10916-3334
Mailing Address - Country:US
Mailing Address - Phone:845-496-9487
Mailing Address - Fax:845-496-9487
Practice Address - Street 1:6 OAK LN
Practice Address - Street 2:
Practice Address - City:CAMPBELL HALL
Practice Address - State:NY
Practice Address - Zip Code:10916-3334
Practice Address - Country:US
Practice Address - Phone:845-496-9487
Practice Address - Fax:845-496-9487
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001069-1133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered