Active NPI
Courtney Lee Gravenese, MS, RD
- Registered Dietitian
- Montclair, NJ
National Provider Identifier
1912064239
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 005045-1
- Practice address
- 460 Bloomfield Ave
Montclair, NJ 07042-3582 - Phone
- (973) 734-0780
- NPI assigned
- Jan 3, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 005045-1 | NY | Primary |
Addresses
Primary practice location
460 Bloomfield Ave
Montclair, NJ 07042-3582
Mailing address
92 Hillside Ave
Verona, NJ 07044-1023
Phone (646) 373-3651
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 005045-1 | NY | MD | Registered Dietitian |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Nourish, Inc. | Dietitian, Registered | Past | Accepting new patients |
| Institute for Change | Dietitian, Registered | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1167782400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1912064239",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "92 HILLSIDE AVE",
"city": "VERONA",
"state": "NJ",
"postal_code": "070441023",
"telephone_number": "646-373-3651"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "460 BLOOMFIELD AVE",
"city": "MONTCLAIR",
"state": "NJ",
"postal_code": "070423582",
"telephone_number": "973-734-0780"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRAVENESE",
"first_name": "COURTNEY",
"middle_name": "LEE",
"name_prefix": "Ms.",
"credential": "MS, RD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-01-03",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "NY",
"license": "005045-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Montclair, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.