Provider Demographics
NPI:1942511183
Name:DELLA CROCE, STEPHEN (MS, RD, CDN)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:DELLA CROCE
Suffix:
Gender:M
Credentials:MS, RD, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 LAKEVIEW RD
Mailing Address - Street 2:
Mailing Address - City:BELLMORE
Mailing Address - State:NY
Mailing Address - Zip Code:11710-4209
Mailing Address - Country:US
Mailing Address - Phone:917-975-7946
Mailing Address - Fax:866-610-7443
Practice Address - Street 1:405 RXR PLZ
Practice Address - Street 2:
Practice Address - City:UNIONDALE
Practice Address - State:NY
Practice Address - Zip Code:11556-3811
Practice Address - Country:US
Practice Address - Phone:800-741-6638
Practice Address - Fax:866-610-7443
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-22
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006034133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY100318993601Medicaid
NY9739196293OtherMEDICARE PACID
NY100318993601Medicaid