Healthcare Provider Details

I. General information

NPI: 1053745695
Provider Name (Legal Business Name): MARINA ANNE VINEIS R.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2013
Last Update Date: 08/31/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1278 YARDVILLE ALLENTOWN RD
ALLENTOWN NJ
08501-1866
US

IV. Provider business mailing address

41 BLACK ROCK TER
RINGWOOD NJ
07456-2903
US

V. Phone/Fax

Practice location:
  • Phone: 609-738-3143
  • Fax:
Mailing address:
  • Phone: 973-476-8109
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number01082681
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: