Healthcare Provider Details

I. General information

NPI: 1346104387
Provider Name (Legal Business Name): MARY-ELLEN DORFMAN MPH, RD, CDN, LD/N
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 SULLIVAN FARM
NEW MILFORD CT
06776-4542
US

IV. Provider business mailing address

30 SULLIVAN FARM
NEW MILFORD CT
06776-4542
US

V. Phone/Fax

Practice location:
  • Phone: 917-453-4267
  • Fax:
Mailing address:
  • Phone: 917-453-4267
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number3030
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: