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NPI Code Detail

MEDICARE: MRS. CAROL LYNN SEPTIMUS RD,CDN

MEDICARE: MRS. CAROL LYNN SEPTIMUS RD,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
1133V00000XRegistered Dietitian003284-1NY

General Provider Information

NPI Number : 1932340973
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. CAROL LYNN SEPTIMUS RD,CDN
Provider Business Mailing Address
First Line : 14443 70TH AVE
Second Line :
City : FLUSHING
State : NY
Zip : 11367-1713
Country : US
Telephone Number : 718-268-4338
Fax Number : 718-268-4338
Provider Business Practice Location Address
First Line : 14443 70TH AVE
Second Line :
City : FLUSHING
State : NY
Zip : 11367-1713
Country : US
Telephone Number : 718-268-4338
Fax Number : 718-268-4338
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/22/2009
Last Update Date : 03/22/2009

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