MEDICARE: YVONNE MULLMAN RD

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	005659	NY

General Provider Information

NPI Number	:	1639296627
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YVONNE MULLMAN RD

Provider Business Mailing Address
First Line	:	5 WENDY LN
Second Line	:
City	:	EAST NORTHPORT
State	:	NY
Zip	:	11731-4813
Country	:	US
Telephone Number	:	631-368-1454
Fax Number	:

Provider Business Practice Location Address
First Line	:	160 HOWELLS RD
Second Line	:
City	:	BAY SHORE
State	:	NY
Zip	:	11706-5320
Country	:	US
Telephone Number	:	631-666-4297
Fax Number	:

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

Provider Enumeration Date	:	03/23/2007
Last Update Date	:	07/08/2007

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