Provider Demographics
NPI:1851587489
Name:MORGENROTH, DIANE (MNT RD CDN)
Entity Type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:
Last Name:MORGENROTH
Suffix:
Gender:F
Credentials:MNT RD CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 FRANKLIN AVE
Mailing Address - Street 2:
Mailing Address - City:LYNBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11563-1215
Mailing Address - Country:US
Mailing Address - Phone:516-569-3842
Mailing Address - Fax:516-887-0030
Practice Address - Street 1:7 FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:LYNBROOK
Practice Address - State:NY
Practice Address - Zip Code:11563-1215
Practice Address - Country:US
Practice Address - Phone:516-569-3842
Practice Address - Fax:516-887-0030
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-18
Last Update Date:2007-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0022271133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03P621Medicare PIN