Provider Demographics
NPI:1487880498
Name:MICHELE L. SEVERINI RD., CDN., LLC.
Entity type:Organization
Organization Name:MICHELE L. SEVERINI RD., CDN., LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:SEVERINI
Authorized Official - Suffix:
Authorized Official - Credentials:RD, CDN
Authorized Official - Phone:201-519-9454
Mailing Address - Street 1:PO BOX 219
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07303-0219
Mailing Address - Country:US
Mailing Address - Phone:201-519-9454
Mailing Address - Fax:
Practice Address - Street 1:326 7TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-3311
Practice Address - Country:US
Practice Address - Phone:718-832-7888
Practice Address - Fax:718-832-6888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-04
Last Update Date:2009-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ006343133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty