MEDICARE: TIFFANY MENDELL MS, RDN, CDN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	007134	NY

General Provider Information

NPI Number	:	1346632114
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIFFANY MENDELL MS, RDN, CDN

Provider Business Mailing Address
First Line	:	131 E 81ST ST
Second Line	:	APT. 6
City	:	NEW YORK
State	:	NY
Zip	:	10028-1463
Country	:	US
Telephone Number	:	917-748-5823
Fax Number	:

Provider Business Practice Location Address
First Line	:	641 LEXINGTON AVE
Second Line	:	SUITE 1411
City	:	NEW YORK
State	:	NY
Zip	:	10022-4503
Country	:	US
Telephone Number	:	212-634-6494
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/03/2015
Last Update Date	:	03/03/2015

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