Individual
MR. MARK ANTHONY DOUBLET
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
R.D., C.D.E.
Contact information
Practice address
75 N COUNTRY RD, PORT JEFFERSON, NY 11777-2119
(631) 686-2505
Mailing address
215 WESTVIEW AVE, DEER PARK, NY 11729-6404
(516) 523-4413
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
1005065
NY
Other
Enumeration date
12/03/2016
Last updated
12/03/2016
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