Healthcare Provider Details

I. General information

NPI: 1982230504
Provider Name (Legal Business Name): DEANNA C. MAGNAYE RDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2020
Last Update Date: 03/15/2020
Certification Date: 03/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 W JERSEY ST STE 104
ELIZABETH NJ
07202-1352
US

IV. Provider business mailing address

17 PARK AVE
KEARNY NJ
07032-1634
US

V. Phone/Fax

Practice location:
  • Phone: 908-469-9440
  • Fax:
Mailing address:
  • Phone: 201-463-2373
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86102529
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: