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NPI Code Detail

MEDICARE: LYNN P HILLERY MS RD CDN

MEDICARE: LYNN P HILLERY 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
1133V00000XRegistered Dietitian006087-1NY

General Provider Information

NPI Number : 1295827103
Entity Type Code : Individual
Provider Name (Legal Business Name) : LYNN P HILLERY MS RD CDN
Provider Business Mailing Address
First Line : 25 ANDREA LN
Second Line :
City : WEST SAYVILLE
State : NY
Zip : 11796-1515
Country : US
Telephone Number : 631-343-2024
Fax Number : 631-343-2024
Provider Business Practice Location Address
First Line : 76 SOUTHAVEN AVE STE 2
Second Line :
City : MEDFORD
State : NY
Zip : 11763-3745
Country : US
Telephone Number : 631-343-2024
Fax Number : 631-343-2024
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/28/2006
Last Update Date : 06/07/2010

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