Healthcare Provider Details

I. General information

NPI: 1558654434
Provider Name (Legal Business Name): EILEEN LINDEMANN R.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2011
Last Update Date: 04/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 S GREENFIELD RD
GREENFIELD CENTER NY
12833-1314
US

IV. Provider business mailing address

105 S GREENFIELD RD
GREENFIELD CENTER NY
12833-1314
US

V. Phone/Fax

Practice location:
  • Phone: 518-893-2382
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number006656
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: