Healthcare Provider Details

I. General information

NPI: 1306080502
Provider Name (Legal Business Name): WENDY B CEDAR RD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2009
Last Update Date: 05/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 DUBOIS ST ST. LUKE'S CORNWALL HOSPITAL - FOOD & NUTRITION DEPT.
NEWBURGH NY
12550-4851
US

IV. Provider business mailing address

70 DUBOIS ST ST. LUKE'S CORNWALL HOSPITAL - FOOD & NUTRITION DEPT.
NEWBURGH NY
12550-4851
US

V. Phone/Fax

Practice location:
  • Phone: 845-568-2622
  • Fax: 845-568-2965
Mailing address:
  • Phone: 845-568-2622
  • Fax: 845-568-2965

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: