Provider Demographics
NPI:1760862205
Name:DIANE'S 365 NUTRITION LLC
Entity Type:Organization
Organization Name:DIANE'S 365 NUTRITION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NUTRITIONIST
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:BITETTI
Authorized Official - Last Name:MISNER
Authorized Official - Suffix:
Authorized Official - Credentials:RD CDE
Authorized Official - Phone:201-289-0759
Mailing Address - Street 1:281 BLOOMFIELD AVE
Mailing Address - Street 2:PMB 119
Mailing Address - City:VERONA
Mailing Address - State:NJ
Mailing Address - Zip Code:07044-2408
Mailing Address - Country:US
Mailing Address - Phone:201-289-0759
Mailing Address - Fax:
Practice Address - Street 1:147 COLUMBIA TPKE
Practice Address - Street 2:
Practice Address - City:FLORHAM PARK
Practice Address - State:NJ
Practice Address - Zip Code:07932-2113
Practice Address - Country:US
Practice Address - Phone:201-289-0759
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-29
Last Update Date:2015-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ564534133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty