Provider Demographics
NPI:1831653120
Name:RIVIERE, JEANNETTE ELISABET (CDN)
Entity Type:Individual
Prefix:
First Name:JEANNETTE
Middle Name:ELISABET
Last Name:RIVIERE
Suffix:
Gender:F
Credentials:CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 OLD MAMARONECK RD APT 1D4
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10605-2447
Mailing Address - Country:US
Mailing Address - Phone:914-684-1382
Mailing Address - Fax:
Practice Address - Street 1:101 OLD MAMARONECK RD APT 1D4
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10605-2447
Practice Address - Country:US
Practice Address - Phone:732-330-7448
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-30
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002597-1133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist