MEDICARE: MS. LORENA DRAGO MS RD CDN CDE

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	003310-1	NY

General Provider Information

NPI Number	:	1588732341
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LORENA DRAGO MS RD CDN CDE

Provider Business Mailing Address
First Line	:	7140 112TH ST APT 404
Second Line	:
City	:	FOREST HILLS
State	:	NY
Zip	:	11375-4624
Country	:	US
Telephone Number	:	718-263-3926
Fax Number	:

Provider Business Practice Location Address
First Line	:	7140 112TH ST APT 404
Second Line	:
City	:	FOREST HILLS
State	:	NY
Zip	:	11375-4624
Country	:	US
Telephone Number	:	718-263-3926
Fax Number	:

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

Provider Enumeration Date	:	12/01/2006
Last Update Date	:	07/08/2007

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