Individual
MS. COURTNEY LEE GRAVENESE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS, RD
Contact information
Practice address
460 BLOOMFIELD AVE, MONTCLAIR, NJ 07042-3582
(973) 734-0780
Mailing address
92 HILLSIDE AVE, VERONA, NJ 07044-1023
(646) 373-3651
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
005045-1
NY
Other
Enumeration date
01/03/2007
Last updated
07/08/2007
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