Provider Demographics
NPI:1932340973
Name:SEPTIMUS, CAROL LYNN (RD,CDN)
Entity Type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:LYNN
Last Name:SEPTIMUS
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 1:14443 70TH AVE
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367-1713
Mailing Address - Country:US
Mailing Address - Phone:718-268-4338
Mailing Address - Fax:718-268-4338
Practice Address - Street 1:14443 70TH AVE
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11367-1713
Practice Address - Country:US
Practice Address - Phone:718-268-4338
Practice Address - Fax:718-268-4338
Is Sole Proprietor?:No
Enumeration Date:2009-03-22
Last Update Date:2009-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003284-1133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered