Provider Demographics
NPI:1992252258
Name:SELITTO, JANE MARIE (RDN)
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:MARIE
Last Name:SELITTO
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 1:41 E MILL RD
Mailing Address - Street 2:
Mailing Address - City:LONG VALLEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07853-3193
Mailing Address - Country:US
Mailing Address - Phone:908-246-1902
Mailing Address - Fax:
Practice Address - Street 1:41 E MILL RD
Practice Address - Street 2:
Practice Address - City:LONG VALLEY
Practice Address - State:NJ
Practice Address - Zip Code:07853-3193
Practice Address - Country:US
Practice Address - Phone:908-246-1902
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-03
Last Update Date:2023-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ86067395133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered