Provider Demographics
NPI:1063033082
Name:PERROTTA, MARISSA (RDN)
Entity type:Individual
Prefix:MRS
First Name:MARISSA
Middle Name:
Last Name:PERROTTA
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 HUBBARDTON RD
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-8201
Mailing Address - Country:US
Mailing Address - Phone:516-380-0493
Mailing Address - Fax:
Practice Address - Street 1:32 HUBBARDTON RD
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-8201
Practice Address - Country:US
Practice Address - Phone:516-380-0493
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-30
Last Update Date:2020-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ86104467133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered