Healthcare Provider Details

I. General information

NPI: 1023308624
Provider Name (Legal Business Name): MRS. DOROTHY E AIKEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2011
Last Update Date: 04/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 WILBUR RD NYS HVDDSO OPWDD
THIELLS NY
10984-7555
US

IV. Provider business mailing address

11 WILBUR RD NYS HVDDSO OPWDD
THIELLS NY
10984-7555
US

V. Phone/Fax

Practice location:
  • Phone: 845-947-6220
  • Fax: 845-947-6240
Mailing address:
  • Phone: 845-947-6220
  • Fax: 845-947-6240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number0046661
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number852266
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: