Provider Demographics
NPI:1295554350
Name:OSORIO, NADINE MARIE
Entity type:Individual
Prefix:
First Name:NADINE
Middle Name:MARIE
Last Name:OSORIO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 MADISON AVE FL 5
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-1600
Mailing Address - Country:US
Mailing Address - Phone:917-455-6295
Mailing Address - Fax:
Practice Address - Street 1:94-98 MANHATTAN AVENUE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11206-2505
Practice Address - Country:US
Practice Address - Phone:718-388-0390
Practice Address - Fax:718-486-5741
Is Sole Proprietor?:No
Enumeration Date:2024-10-07
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012394-01133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered