Healthcare Provider Details

I. General information

NPI: 1801087515
Provider Name (Legal Business Name): ANTONELLA C CAGGIANO MS, RD, CDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2007
Last Update Date: 01/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1035 E BOSTON POST RD 1-6
MAMARONECK NY
10543-4149
US

IV. Provider business mailing address

1035 E BOSTON POST RD 1-6
MAMARONECK NY
10543-4149
US

V. Phone/Fax

Practice location:
  • Phone: 914-715-3069
  • Fax:
Mailing address:
  • Phone: 914-715-3069
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number896820
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: