Healthcare Provider Details

I. General information

NPI: 1912246877
Provider Name (Legal Business Name): DIANE MARIE CARBONE R.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2013
Last Update Date: 02/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

52 ALPINE RD
YONKERS NY
10710-2002
US

IV. Provider business mailing address

52 ALPINE RD
YONKERS NY
10710-2002
US

V. Phone/Fax

Practice location:
  • Phone: 914-961-3695
  • Fax: 914-793-6638
Mailing address:
  • Phone: 914-961-3695
  • Fax: 914-793-6638

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number003667-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: