MEDICARE: MR. SEREN WECHSLER MS, 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
1	133V00000X	Registered Dietitian	86062441	NY

General Provider Information

NPI Number	:	1154819191
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SEREN WECHSLER MS, RD, CDN

Provider Business Mailing Address
First Line	:	3408 N DEERFIELD AVE
Second Line	:
City	:	YORKTOWN HEIGHTS
State	:	NY
Zip	:	10598-1914
Country	:	US
Telephone Number	:	914-374-6819
Fax Number	:

Provider Business Practice Location Address
First Line	:	3408 N DEERFIELD AVE
Second Line	:
City	:	YORKTOWN HEIGHTS
State	:	NY
Zip	:	10598-1914
Country	:	US
Telephone Number	:	914-374-6819
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/25/2018
Last Update Date	:	04/25/2018

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