Healthcare Provider Details

I. General information

NPI: 1902963168
Provider Name (Legal Business Name): DONNA YANNACONE MS, RD, CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 09/24/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1033 CLIFTON AVE
CLIFTON NJ
07013-3517
US

IV. Provider business mailing address

1033 CLIFTON AVE
CLIFTON NJ
07013-3517
US

V. Phone/Fax

Practice location:
  • Phone: 973-773-8020
  • Fax:
Mailing address:
  • Phone: 973-773-8020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number646536
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: