Provider Demographics
NPI:1366676363
Name:DAILEY, LANE MICHELLE (RD)
Entity Type:Individual
Prefix:MISS
First Name:LANE
Middle Name:MICHELLE
Last Name:DAILEY
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
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Mailing Address - Street 1:1 COLUMBUS PL
Mailing Address - Street 2:N 49C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-8201
Mailing Address - Country:US
Mailing Address - Phone:415-264-1775
Mailing Address - Fax:
Practice Address - Street 1:525 E 68TH ST
Practice Address - Street 2:BOX #92
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-4870
Practice Address - Country:US
Practice Address - Phone:212-746-1011
Practice Address - Fax:212-746-9456
Is Sole Proprietor?:No
Enumeration Date:2009-05-06
Last Update Date:2010-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006700133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA4000018105Medicare PIN