=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598234197
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TINA COVONE RD, CDN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/13/2018
-----------------------------------------------------
Last Update Date | 11/13/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2094 ALBANY POST RD
-----------------------------------------------------
City | MONTROSE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10548-1454
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-737-4400
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 151 BENTON MOORE RD
-----------------------------------------------------
City | HOPEWELL JUNCTION
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12533-6370
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-494-4726
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 133V00000X
-----------------------------------------------------
Taxonomy Name | Registered Dietitian
-----------------------------------------------------
License Number | 009214-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------