Provider Demographics
NPI:1326134479
Name:GAETANI, ANNE PATRICIA (RD, CDE)
Entity Type:Individual
Prefix:MRS
First Name:ANNE
Middle Name:PATRICIA
Last Name:GAETANI
Suffix:
Gender:F
Credentials:RD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 CEDAR LN
Mailing Address - Street 2:
Mailing Address - City:GLENVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12302-5523
Mailing Address - Country:US
Mailing Address - Phone:518-399-1101
Mailing Address - Fax:518-399-1101
Practice Address - Street 1:123 SARATOGA RD
Practice Address - Street 2:
Practice Address - City:SCOTIA
Practice Address - State:NY
Practice Address - Zip Code:12302-4181
Practice Address - Country:US
Practice Address - Phone:518-399-1101
Practice Address - Fax:518-399-1101
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY800835133VN1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYDD6644Medicare PIN