Provider Demographics
NPI:1699146571
Name:BLATTEIS, MELANIE (RD, CDN)
Entity type:Individual
Prefix:MRS
First Name:MELANIE
Middle Name:
Last Name:BLATTEIS
Suffix:
Gender:F
Credentials:RD, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 GULF RD
Mailing Address - Street 2:
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-1362
Mailing Address - Country:US
Mailing Address - Phone:732-828-4942
Mailing Address - Fax:
Practice Address - Street 1:7 GULF RD
Practice Address - Street 2:
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-1362
Practice Address - Country:US
Practice Address - Phone:732-828-4942
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-16
Last Update Date:2015-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000637-1133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered