Healthcare Provider Details

I. General information

NPI: 1093128407
Provider Name (Legal Business Name): SARAH DISSLER OHLINGER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2014
Last Update Date: 06/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 E MAIN ST
HUNTINGTON NY
11743-2979
US

IV. Provider business mailing address

3 BOWEN PL
STONY BROOK NY
11790-2609
US

V. Phone/Fax

Practice location:
  • Phone: 631-368-3706
  • Fax:
Mailing address:
  • Phone: 631-813-9784
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number007550
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: