MEDICARE: MICHELLE SALVA PATELLIS R.D., C.N.S.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	951808	NJ

General Provider Information

NPI Number	:	1942441910
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE SALVA PATELLIS R.D., C.N.S.D.

Provider Business Mailing Address
First Line	:	210 MAIN ST
Second Line	:
City	:	MADISON
State	:	NJ
Zip	:	07940-2285
Country	:	US
Telephone Number	:	520-603-3157
Fax Number	:

Provider Business Practice Location Address
First Line	:	210 MAIN ST
Second Line	:
City	:	MADISON
State	:	NJ
Zip	:	07940-2285
Country	:	US
Telephone Number	:	973-377-6700
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/20/2009
Last Update Date	:	03/28/2009

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