Provider Demographics
NPI:1588135388
Name:MIDDLETON, OLIVIA (MS, RD, LD, CDN)
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:
Last Name:MIDDLETON
Suffix:
Gender:F
Credentials:MS, RD, LD, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 W 114TH ST FL 2
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-1796
Mailing Address - Country:US
Mailing Address - Phone:212-523-2206
Mailing Address - Fax:
Practice Address - Street 1:440 W 114TH ST FL 2
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-1796
Practice Address - Country:US
Practice Address - Phone:212-523-2206
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-06
Last Update Date:2018-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered