Provider Demographics
NPI:1154577880
Name:MAGNANI, COLLEEN MARIE (RD)
Entity type:Individual
Prefix:MRS
First Name:COLLEEN
Middle Name:MARIE
Last Name:MAGNANI
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:COLLEEN
Other - Middle Name:MARIE
Other - Last Name:FITZGERALD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:93 FRANKLIN TURNPIKE
Mailing Address - Street 2:
Mailing Address - City:WARDWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:07463-1820
Mailing Address - Country:US
Mailing Address - Phone:201-312-7153
Mailing Address - Fax:201-603-6406
Practice Address - Street 1:93 FRANKLIN TPKE
Practice Address - Street 2:
Practice Address - City:WALDWICK
Practice Address - State:NJ
Practice Address - Zip Code:07463-1820
Practice Address - Country:US
Practice Address - Phone:201-312-7153
Practice Address - Fax:201-603-6406
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-13
Last Update Date:2015-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ978514133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
978514OtherREGISTERED DIETITIAN