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NPI Code Detail

MEDICARE: MS. MARY DOLORES EMMICK R.D.

MEDICARE: MS. MARY DOLORES EMMICK R.D.
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 Dietitian445423NY

General Provider Information

NPI Number : 1912931114
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. MARY DOLORES EMMICK R.D.
Provider Business Mailing Address
First Line : 11110 ALEXANDER RD
Second Line :
City : ATTICA
State : NY
Zip : 14011-9426
Country : US
Telephone Number : 585-591-1878
Fax Number :
Provider Business Practice Location Address
First Line : 222 RICHMOND AVE
Second Line :
City : BATAVIA
State : NY
Zip : 14020-1227
Country : US
Telephone Number : 585-297-1031
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/11/2006
Last Update Date : 07/08/2007

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