Provider Demographics
NPI:1780886028
Name:SANTINI, DOREEN DAWN (RD)
Entity type:Individual
Prefix:MRS
First Name:DOREEN
Middle Name:DAWN
Last Name:SANTINI
Suffix:
Gender:F
Credentials:RD
Other - Prefix:MISS
Other - First Name:DOREEN
Other - Middle Name:DAWN
Other - Last Name:KOENIG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:12 COPTER CT
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-2335
Mailing Address - Country:US
Mailing Address - Phone:631-549-2689
Mailing Address - Fax:
Practice Address - Street 1:380 S OYSTER BAY RD
Practice Address - Street 2:
Practice Address - City:HICKSVILLE
Practice Address - State:NY
Practice Address - Zip Code:11801-3509
Practice Address - Country:US
Practice Address - Phone:516-901-4143
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005613-1133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0390G1Medicare ID - Type Unspecified