Provider Demographics
NPI:1023745221
Name:DELLATTE, JUSTINE (RDN)
Entity type:Individual
Prefix:
First Name:JUSTINE
Middle Name:
Last Name:DELLATTE
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 VAN ORDEN AVE
Mailing Address - Street 2:
Mailing Address - City:SUFFERN
Mailing Address - State:NY
Mailing Address - Zip Code:10901-6330
Mailing Address - Country:US
Mailing Address - Phone:845-596-8615
Mailing Address - Fax:
Practice Address - Street 1:92 BRIDGE AVE STE 202
Practice Address - Street 2:
Practice Address - City:BAY HEAD
Practice Address - State:NJ
Practice Address - Zip Code:08742-5068
Practice Address - Country:US
Practice Address - Phone:732-701-7126
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-07
Last Update Date:2022-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY86085171133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered