Provider Demographics
NPI:1346632114
Name:MENDELL, TIFFANY (MS, RDN, CDN)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:MENDELL
Suffix:
Gender:F
Credentials:MS, RDN, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 E 81ST ST
Mailing Address - Street 2:APT. 6
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-1463
Mailing Address - Country:US
Mailing Address - Phone:917-748-5823
Mailing Address - Fax:
Practice Address - Street 1:641 LEXINGTON AVE
Practice Address - Street 2:SUITE 1411
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-4503
Practice Address - Country:US
Practice Address - Phone:212-634-6494
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-03
Last Update Date:2015-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007134133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered