Provider Demographics
NPI:1043889280
Name:MONGIOI, MARISA JULIANA (RDN)
Entity type:Individual
Prefix:
First Name:MARISA
Middle Name:JULIANA
Last Name:MONGIOI
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 1:301 CRANBERRY RD
Mailing Address - Street 2:
Mailing Address - City:FARMINGDALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07727-3510
Mailing Address - Country:US
Mailing Address - Phone:732-259-3369
Mailing Address - Fax:
Practice Address - Street 1:301 CRANBERRY RD
Practice Address - Street 2:
Practice Address - City:FARMINGDALE
Practice Address - State:NJ
Practice Address - Zip Code:07727-3510
Practice Address - Country:US
Practice Address - Phone:732-259-3369
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-22
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY86149910133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered