Provider Demographics
NPI:1902357288
Name:STOPLER, TRACY (RD)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:STOPLER
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 GARYNSON CT
Mailing Address - Street 2:
Mailing Address - City:PLAINVIEW
Mailing Address - State:NY
Mailing Address - Zip Code:11803-6029
Mailing Address - Country:US
Mailing Address - Phone:516-931-3837
Mailing Address - Fax:
Practice Address - Street 1:19 GARYNSON CT
Practice Address - Street 2:
Practice Address - City:PLAINVIEW
Practice Address - State:NY
Practice Address - Zip Code:11803-6029
Practice Address - Country:US
Practice Address - Phone:516-931-3837
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-20
Last Update Date:2016-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY726186133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered