Healthcare Provider Details

I. General information

NPI: 1083653562
Provider Name (Legal Business Name): JAMIE HOCHMAN DEAN RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 04/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 CAROLYN DR
CORTLANDT MANOR NY
10567-7316
US

IV. Provider business mailing address

2094 ALBANY POST RD
MONTROSE NY
10548-1454
US

V. Phone/Fax

Practice location:
  • Phone: 914-420-3752
  • Fax:
Mailing address:
  • Phone: 914-788-4269
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number000051
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: