Provider Demographics
NPI:1538827837
Name:VICTA, A-RIAN VINCE (RDNCDN)
Entity type:Individual
Prefix:
First Name:A-RIAN VINCE
Middle Name:
Last Name:VICTA
Suffix:
Gender:M
Credentials:RDNCDN
Other - Prefix:
Other - First Name:VINCE
Other - Middle Name:
Other - Last Name:VICTA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:150 W 47TH STREET
Mailing Address - Street 2:PHD
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10036
Mailing Address - Country:US
Mailing Address - Phone:775-413-4135
Mailing Address - Fax:
Practice Address - Street 1:150 W 47TH STREET
Practice Address - Street 2:PHD
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10036
Practice Address - Country:US
Practice Address - Phone:775-413-4135
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-03
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY86176949133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered