Provider Demographics
NPI:1013047398
Name:CESARANO-CAPUTO, FAY A (RD-CDN)
Entity Type:Individual
Prefix:
First Name:FAY
Middle Name:A
Last Name:CESARANO-CAPUTO
Suffix:
Gender:F
Credentials:RD-CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:89 W RIDGEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450-3142
Mailing Address - Country:US
Mailing Address - Phone:201-632-3077
Mailing Address - Fax:
Practice Address - Street 1:89 W RIDGEWOOD AVE
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450-3142
Practice Address - Country:US
Practice Address - Phone:201-632-3077
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2019-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004767133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00695941Medicaid
NY331946Medicare ID - Type Unspecified
NY00695941Medicaid