MEDICARE: MS. ALLISON PATRICIA BACKER RDN

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	00961324	NY

General Provider Information

NPI Number	:	1497246383
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ALLISON PATRICIA BACKER RDN

Provider Business Mailing Address
First Line	:	1737 N OCEAN AVE STE C&D
Second Line	:
City	:	MEDFORD
State	:	NY
Zip	:	11763-2649
Country	:	US
Telephone Number	:	631-941-2000
Fax Number	:	631-941-2010

Provider Business Practice Location Address
First Line	:	1737 N OCEAN AVE STE C&D
Second Line	:
City	:	MEDFORD
State	:	NY
Zip	:	11763-2649
Country	:	US
Telephone Number	:	631-941-2000
Fax Number	:	631-941-2010

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

Provider Enumeration Date	:	05/25/2018
Last Update Date	:	02/12/2026

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