Provider Demographics
NPI:1497160287
Name:FINE, RACHEL (MS, RD, CSSD, CDN)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:FINE
Suffix:
Gender:F
Credentials:MS, RD, CSSD, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:475 NORTHERN BLVD
Mailing Address - Street 2:34
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-4819
Mailing Address - Country:US
Mailing Address - Phone:516-316-2491
Mailing Address - Fax:
Practice Address - Street 1:475 NORTHERN BLVD
Practice Address - Street 2:34
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-4819
Practice Address - Country:US
Practice Address - Phone:516-316-2491
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-30
Last Update Date:2016-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007854133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered