Individual
DIANE FORTINO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
R.D.
Contact information
Practice address
240 E GLEN AVE, RIDGEWOOD, NJ 07450-1736
(201) 214-9253
Mailing address
240 E GLEN AVE, RIDGEWOOD, NJ 07450-1736
(201) 214-9253
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
634184
NY
Other
Enumeration date
06/19/2015
Last updated
06/19/2015
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