Healthcare Provider Details

I. General information

NPI: 1982849287
Provider Name (Legal Business Name): VICTORIA ROUSSO KOBLINER RD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/16/2008
Last Update Date: 06/01/2025
Certification Date: 06/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 DANBURY RD
WILTON CT
06897-4437
US

IV. Provider business mailing address

3555 OXFORD AVE APT 5J
BRONX NY
10463-1721
US

V. Phone/Fax

Practice location:
  • Phone: 203-834-9949
  • Fax: 203-834-9938
Mailing address:
  • Phone: 203-665-8558
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number000354
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: