Healthcare Provider Details

I. General information

NPI: 1366736548
Provider Name (Legal Business Name): DENISE ANN MOKOTOFF MS, RD, CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2011
Last Update Date: 06/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 PORT WASHINGTON BLVD
ROSLYN NY
11576-1347
US

IV. Provider business mailing address

19 CHASSYL RD
COMMACK NY
11725-4803
US

V. Phone/Fax

Practice location:
  • Phone: 516-629-2069
  • Fax:
Mailing address:
  • Phone: 631-864-1833
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number000341-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: