Healthcare Provider Details

I. General information

NPI: 1043857469
Provider Name (Legal Business Name): TARA LYNN HILL MS, RDN, CLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2019
Last Update Date: 05/09/2024
Certification Date: 05/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 1ST AVE
ORANGEBURG NY
10962-1106
US

IV. Provider business mailing address

8 GLEN LN
MONTVALE NJ
07645-2206
US

V. Phone/Fax

Practice location:
  • Phone: 845-680-4000
  • Fax:
Mailing address:
  • Phone: 201-240-6594
  • Fax:

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: