Provider Demographics
NPI:1134810989
Name:MARINO, COURTNEY M (RDN)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:M
Last Name:MARINO
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 1:70 LAKE SHORE DR
Mailing Address - Street 2:
Mailing Address - City:ROCKAWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:07866-1409
Mailing Address - Country:US
Mailing Address - Phone:973-294-8232
Mailing Address - Fax:
Practice Address - Street 1:700 MULLICA HILL RD
Practice Address - Street 2:
Practice Address - City:MULLICA HILL
Practice Address - State:NJ
Practice Address - Zip Code:08062-4413
Practice Address - Country:US
Practice Address - Phone:856-508-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-15
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
86297619133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered