Provider Demographics
NPI:1346372265
Name:OKSMAN, MARY JANE (RD CDN CDE)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:JANE
Last Name:OKSMAN
Suffix:
Gender:F
Credentials:RD CDN CDE
Other - Prefix:MS
Other - First Name:MARY
Other - Middle Name:JANE
Other - Last Name:ILARDO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4200 LAKESHORE ROAD
Mailing Address - Street 2:
Mailing Address - City:HAMBURG
Mailing Address - State:NY
Mailing Address - Zip Code:14075-2044
Mailing Address - Country:US
Mailing Address - Phone:716-627-3391
Mailing Address - Fax:
Practice Address - Street 1:4200 LAKESHORE ROAD
Practice Address - Street 2:
Practice Address - City:HAMBURG
Practice Address - State:NY
Practice Address - Zip Code:14075-2044
Practice Address - Country:US
Practice Address - Phone:716-627-3391
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0009691133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY6503767OtherIHA
NY6503767OtherIHA