Provider Demographics
NPI:1568816825
Name:OPFER, MARY (MS, RDN, CDN)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:OPFER
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 1:11 GREEN TREE RD
Mailing Address - Street 2:
Mailing Address - City:YORKTOWN HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:10598-6327
Mailing Address - Country:US
Mailing Address - Phone:914-774-8530
Mailing Address - Fax:
Practice Address - Street 1:11 GREEN TREE RD
Practice Address - Street 2:
Practice Address - City:YORKTOWN HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:10598-6327
Practice Address - Country:US
Practice Address - Phone:914-774-8530
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-22
Last Update Date:2019-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001534133V00000X
NY007758133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered