Organization
SHANE FIT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MICHELLE MAIDENBERG M.D. (MEDICAL DOCTOR)
(626) 797-9977
Entity
Organization
Contact information
Practice address
134 TEATOWN ROAD, CROTON ON HUDSON, CA 90265
(626) 797-9977
Mailing address
134 TEATOWN RD, CROTON ON HUDSON, NY 10520-3524
(626) 797-9977
Taxonomy
Speciality
Code
Description
License number
State
132700000X
Dietary Manager
Primary
R049213-1
NY
Other
Enumeration date
04/16/2012
Last updated
04/16/2012
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