Individual
MR. CLINTON HAROLD WATTENBERG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RD
Contact information
Practice address
949 E STATE ST, ITHACA, NY 14850-6158
(607) 227-9344
Mailing address
949 E STATE ST, ITHACA, NY 14850-6158
(607) 227-9344
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
1044495
NY
133VN1004X
Pediatric Nutrition Registered Dietitian
1044495
NY
133VN1006X
Metabolic Nutrition Registered Dietitian
1044495
NY
390200000X
Student in an Organized Health Care Education/Training Program
1044495
NY
Other
Enumeration date
08/26/2011
Last updated
08/26/2011
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