Individual
TRACI FIELDS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RPA-C
Contact information
Practice address
110 E 40TH ST, 606, NEW YORK, NY 10016-1801
(212) 685-3640
Mailing address
110 E 40TH ST, 606, NEW YORK, NY 10016-1801
(212) 685-3640
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
004737
NY
363AM0700X
Medical Physician Assistant
Primary
008971-1
NY
Other
Enumeration date
11/16/2007
Last updated
04/30/2011
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