Provider Demographics
NPI:1891858510
Name:COLACINO, MELODY (RD)
Entity Type:Individual
Prefix:MRS
First Name:MELODY
Middle Name:
Last Name:COLACINO
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 1:311 W 43RD ST
Mailing Address - Street 2:SUITE 1101
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10036-6413
Mailing Address - Country:US
Mailing Address - Phone:212-315-1412
Mailing Address - Fax:212-315-1442
Practice Address - Street 1:311 W 43RD ST
Practice Address - Street 2:SUITE 1101
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10036-6413
Practice Address - Country:US
Practice Address - Phone:212-315-1412
Practice Address - Fax:212-315-1442
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ966908133V00000X
NY966908133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2693256OtherUNITED HEALTHCARE
NJ7654551OtherAETNA