1467797100 NPI number — MARINA STAUFFER, REGISTERED DIETITIAN, CERTIFIED DIETITIAN NUTRITIONIS

Table of content: DR. WILLIAM CARY ALDERMAN D.C. (NPI 1225147507)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467797100 NPI number — MARINA STAUFFER, REGISTERED DIETITIAN, CERTIFIED DIETITIAN NUTRITIONIS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARINA STAUFFER, REGISTERED DIETITIAN, CERTIFIED DIETITIAN NUTRITIONIS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1467797100
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/28/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
44 CHERRY LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HUNTINGTON
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11743-2945
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-374-6371
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
694 FORT SALONGA RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTHPORT
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11768-3147
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-374-6371
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/06/2012

Additional Information

Authorized Official

Authorized Official Last Name:
STAUFFER
Authorized Official First Name:
MARINA
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
631-374-6371

Provider Taxonomy Codes

  • Taxonomy code: 133V00000X , with the licence number:  007284-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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