Provider Demographics
NPI:1407157050
Name:AGUINALDO, MARIE GERTRUDE (RD)
Entity type:Individual
Prefix:MISS
First Name:MARIE
Middle Name:GERTRUDE
Last Name:AGUINALDO
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 BEVERLY RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07081-3015
Mailing Address - Country:US
Mailing Address - Phone:201-376-3255
Mailing Address - Fax:
Practice Address - Street 1:29 AVENUE E
Practice Address - Street 2:
Practice Address - City:BAYONNE
Practice Address - State:NJ
Practice Address - Zip Code:07002-2555
Practice Address - Country:US
Practice Address - Phone:201-376-3255
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-14
Last Update Date:2010-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
727850133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered