Provider Demographics
NPI:1649612912
Name:WORTHMAN-LEVA, JANE (MS, RD)
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:
Last Name:WORTHMAN-LEVA
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:JANE
Other - Middle Name:A
Other - Last Name:WORTHMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:357 SOUTH IRVING ST.
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450
Mailing Address - Country:US
Mailing Address - Phone:201-819-0563
Mailing Address - Fax:201-612-9771
Practice Address - Street 1:357 SOUTH IRVING ST
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450
Practice Address - Country:US
Practice Address - Phone:201-819-0563
Practice Address - Fax:201-612-9771
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-26
Last Update Date:2013-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
884262133N00000X, 133NN1002X, 133V00000X, 133VN1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
No133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic