Provider Demographics
NPI:1669042453
Name:WIENER, STEFANIE (RDN, CDN)
Entity Type:Individual
Prefix:
First Name:STEFANIE
Middle Name:
Last Name:WIENER
Suffix:
Gender:F
Credentials:RDN, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 E 54TH ST APT 8H
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-5174
Mailing Address - Country:US
Mailing Address - Phone:516-382-5807
Mailing Address - Fax:
Practice Address - Street 1:200 E 78TH ST STE 1A
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10075-2010
Practice Address - Country:US
Practice Address - Phone:212-203-2146
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-25
Last Update Date:2021-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010484133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered