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NPI Code Detail

MEDICARE: MRS. ANN MICHELLE PINNATA MS RD

MEDICARE: MRS. ANN MICHELLE PINNATA MS RD
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
1133V00000XRegistered Dietitian851394NY

General Provider Information

NPI Number : 1689865511
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. ANN MICHELLE PINNATA MS RD
Provider Business Mailing Address
First Line : PO BOX 26
Second Line :
City : PORT JEFFERSON STATION
State : NY
Zip : 11776-0026
Country : US
Telephone Number : 631-675-6955
Fax Number : 631-675-6956
Provider Business Practice Location Address
First Line : 80 N COUNTRY RD
Second Line :
City : PORT JEFFERSON
State : NY
Zip : 11777-2120
Country : US
Telephone Number : 631-675-6955
Fax Number : 631-675-6956
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/06/2007
Last Update Date : 08/06/2007

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