Provider Demographics
NPI:1790403103
Name:WEIZENECKER, CAROLINE L (RD, CDN)
Entity Type:Individual
Prefix:MRS
First Name:CAROLINE
Middle Name:L
Last Name:WEIZENECKER
Suffix:
Gender:F
Credentials:RD, CDN
Other - Prefix:
Other - First Name:CARI
Other - Middle Name:L
Other - Last Name:WEIZENECKER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:996 ROUTE 311
Mailing Address - Street 2:
Mailing Address - City:PATTERSON
Mailing Address - State:NY
Mailing Address - Zip Code:12563-2707
Mailing Address - Country:US
Mailing Address - Phone:203-545-8227
Mailing Address - Fax:
Practice Address - Street 1:996 ROUTE 311
Practice Address - Street 2:
Practice Address - City:PATTERSON
Practice Address - State:NY
Practice Address - Zip Code:12563-2707
Practice Address - Country:US
Practice Address - Phone:120-354-5822
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-22
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY711260133NN1002X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education