Healthcare Provider Details

I. General information

NPI: 1215710728
Provider Name (Legal Business Name): PATTI MORANE ESPOSITO RDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2023
Last Update Date: 01/05/2024
Certification Date: 01/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 VALLEY RD APT E
MONTCLAIR NJ
07042-2310
US

IV. Provider business mailing address

124 VALLEY RD APT E
MONTCLAIR NJ
07042-2310
US

V. Phone/Fax

Practice location:
  • Phone: 516-413-1371
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86109736
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: