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General NPI Number Information
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NPI Number | 1003941345
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Entity Type | Individual
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Provider Name | ANN FAICCO RDCDN
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Gender | Female
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Dates
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Enumeration Date | 02/23/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 223 NORTH VAN DIEN AVENUE
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City | RIDGEWOOD
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State | NJ
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Zip | 07450-2736
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Country | US
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Telephone | 201-634-5355
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Fax | 201-634-5385
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Provider Business Mailing Address
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Address Line | 10 BRADLEY DR
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City | NEW CITY
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State | NY
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Zip | 10956
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Country | US
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Telephone | 845-634-1567
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Fax | 201-634-5385
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 720814
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License Number State |
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