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General NPI Number Information
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NPI Number | 1417105743
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Entity Type | Individual
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Provider Name | THERESA CANTILLI
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Gender | Female
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Dates
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Enumeration Date | 08/28/2008
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Last Update Date | 08/28/2008
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Provider Practice Location Address
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Address Line | 2800 MARCUS AVE
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City | NEW HYDE PARK
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State | NY
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Zip | 11042-1008
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Country | US
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Telephone | 516-708-2500
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Fax | 516-708-2580
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Provider Business Mailing Address
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Address Line | 972 BRUSH HOLLOW RD
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City | WESTBURY
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State | NY
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Zip | 11590-1740
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Country | US
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Telephone | 516-876-5555
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Fax | 516-876-1246
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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 | 709611
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License Number State | NY
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