Provider Demographics
NPI:1831635044
Name:DZAMA, JOANNE M (ATC, RD)
Entity Type:Individual
Prefix:MRS
First Name:JOANNE
Middle Name:M
Last Name:DZAMA
Suffix:
Gender:F
Credentials:ATC, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 CONCORD DR
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039-4313
Mailing Address - Country:US
Mailing Address - Phone:908-217-3953
Mailing Address - Fax:
Practice Address - Street 1:41 CONCORD DR
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039-4313
Practice Address - Country:US
Practice Address - Phone:908-217-3953
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-11
Last Update Date:2017-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ897432133V00000X
NJ25MT00064700174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered