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NPI Code Detail

MEDICARE: MARA LYNNE TROJANSKI RD,CDN

MEDICARE: MARA LYNNE TROJANSKI RD,CDN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1133V00000XRegistered Dietitian001803-1NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1040426003112OTHERNMFIDELIS

General Provider Information

NPI Number : 1144264656
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARA LYNNE TROJANSKI RD,CDN
Provider Business Mailing Address
First Line : 300 WEST AVE
Second Line :
City : BROCKPORT
State : NY
Zip : 14420-1118
Country : US
Telephone Number : 585-637-3905
Fax Number : 585-637-4990
Provider Business Practice Location Address
First Line : 300 WEST AVE
Second Line :
City : BROCKPORT
State : NY
Zip : 14420-1118
Country : US
Telephone Number : 585-637-3905
Fax Number : 585-637-4990
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/15/2006
Last Update Date : 07/08/2007

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