MEDICARE: MS. ERICA L KABELI 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	133N00000X	Nutritionist	006149-1	NY

General Provider Information

NPI Number	:	1508018714
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ERICA L KABELI CDN

Provider Business Mailing Address
First Line	:	PO BOX 119
Second Line	:
City	:	WOODBOURNE
State	:	NY
Zip	:	12788-0119
Country	:	US
Telephone Number	:	845-434-5793
Fax Number	:

Provider Business Practice Location Address
First Line	:	6354 RTE 42
Second Line	:
City	:	WOODBOURNE
State	:	NY
Zip	:	12788
Country	:	US
Telephone Number	:	845-434-5793
Fax Number	:

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

Provider Enumeration Date	:	10/21/2008
Last Update Date	:	10/21/2008

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