Provider Demographics
NPI:1851613491
Name:MARINACCIO, TINA (RD)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:
Last Name:MARINACCIO
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 1:7 COLUMBIA TPKE
Mailing Address - Street 2:7 COLUMBIA TPKE.
Mailing Address - City:FLORHAM PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07932
Mailing Address - Country:US
Mailing Address - Phone:973-765-9355
Mailing Address - Fax:
Practice Address - Street 1:7 COLUMBIA TPKE
Practice Address - Street 2:C/O STORCH
Practice Address - City:FLORHAM PARK
Practice Address - State:NJ
Practice Address - Zip Code:07932-2275
Practice Address - Country:US
Practice Address - Phone:973-765-9355
Practice Address - Fax:973-765-9366
Is Sole Proprietor?:No
Enumeration Date:2010-02-24
Last Update Date:2022-01-05
Deactivation Date:2021-09-10
Deactivation Code:
Reactivation Date:2022-01-05
Provider Licenses
StateLicense IDTaxonomies
NJ870621133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered