Provider Demographics
NPI:1073938908
Name:LIAKOS, MARIANNE (RD)
Entity Type:Individual
Prefix:
First Name:MARIANNE
Middle Name:
Last Name:LIAKOS
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 COOPER DR.
Mailing Address - Street 2:
Mailing Address - City:VERBANK
Mailing Address - State:NY
Mailing Address - Zip Code:12585
Mailing Address - Country:US
Mailing Address - Phone:845-677-9240
Mailing Address - Fax:
Practice Address - Street 1:151 COOPER DR.
Practice Address - Street 2:
Practice Address - City:VERBANK
Practice Address - State:NY
Practice Address - Zip Code:12585
Practice Address - Country:US
Practice Address - Phone:845-677-9240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-01
Last Update Date:2014-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003893-1133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered