Provider Demographics
NPI:1861201659
Name:RUSINOVA, VIKTORIA (RDN)
Entity type:Individual
Prefix:
First Name:VIKTORIA
Middle Name:
Last Name:RUSINOVA
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 1:18 DAFFODIL WAY
Mailing Address - Street 2:
Mailing Address - City:OLD BRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:08857-3592
Mailing Address - Country:US
Mailing Address - Phone:718-300-1544
Mailing Address - Fax:
Practice Address - Street 1:18 DAFFODIL WAY
Practice Address - Street 2:
Practice Address - City:OLD BRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:08857-3592
Practice Address - Country:US
Practice Address - Phone:718-300-1544
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-06
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
86074030133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered