Provider Demographics
NPI:1265720361
Name:VALENTINE, KATHRYN LEE (RD)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:LEE
Last Name:VALENTINE
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 1:1225 MCBRIDE AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WOODLAND PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07424-3812
Mailing Address - Country:US
Mailing Address - Phone:862-703-9232
Mailing Address - Fax:
Practice Address - Street 1:1225 MCBRIDE AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:WOODLAND PARK
Practice Address - State:NJ
Practice Address - Zip Code:07424-3812
Practice Address - Country:US
Practice Address - Phone:862-703-9232
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-11
Last Update Date:2012-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1044070133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered