Healthcare Provider Details

I. General information

NPI: 1255525036
Provider Name (Legal Business Name): CHRISTINA LIETO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2007
Last Update Date: 09/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

88 VAN SCOY RD
POUGHQUAG NY
12570-5235
US

IV. Provider business mailing address

88 VAN SCOY RD
POUGHQUAG NY
12570-5235
US

V. Phone/Fax

Practice location:
  • Phone: 845-227-6273
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number005428-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: