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NPI Code Detail

MEDICARE: DOLLY ANN CONKLIN RD

MEDICARE: DOLLY ANN CONKLIN 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
1133V00000XRegistered Dietitian006118NY

General Provider Information

NPI Number : 1992751309
Entity Type Code : Individual
Provider Name (Legal Business Name) : DOLLY ANN CONKLIN RD
Provider Business Mailing Address
First Line : 3298 ROUTE 94
Second Line :
City : CHESTER
State : NY
Zip : 10918-4106
Country : US
Telephone Number : 845-457-5555
Fax Number : 845-457-5556
Provider Business Practice Location Address
First Line : 20 WALNUT ST
Second Line : SUITE B
City : MONTGOMERY
State : NY
Zip : 12549-2230
Country : US
Telephone Number : 845-457-5555
Fax Number : 845-457-5556
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/26/2006
Last Update Date : 07/08/2007

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