Provider Demographics
NPI:1912246877
Name:CARBONE, DIANE MARIE (RD)
Entity Type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:MARIE
Last Name:CARBONE
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 1:52 ALPINE RD
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10710-2002
Mailing Address - Country:US
Mailing Address - Phone:914-961-3695
Mailing Address - Fax:914-793-6638
Practice Address - Street 1:52 ALPINE RD
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10710-2002
Practice Address - Country:US
Practice Address - Phone:914-961-3695
Practice Address - Fax:914-793-6638
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-12
Last Update Date:2014-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003667-1133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered