Basic Information
| Provider Information | |||||||||
| NPI: | 1104051648 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HART | ||||||||
| FirstName: | ANDREA | ||||||||
| MiddleName: | FOIT | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | RD, CDN | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | FOIT | ||||||||
| OtherFirstName: | ANDREA | ||||||||
| OtherMiddleName: | BARBARA | ||||||||
| OtherNamePrefix: | MISS | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 701 LENOX AVE | ||||||||
| Address2: | |||||||||
| City: | ONEIDA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 134211500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3153639281 | ||||||||
| FaxNumber: | 3153639286 | ||||||||
| Practice Location | |||||||||
| Address1: | 823 ROUTE 13 | ||||||||
| Address2: | |||||||||
| City: | CORTLAND | ||||||||
| State: | NY | ||||||||
| PostalCode: | 130458835 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6077588850 | ||||||||
| FaxNumber: | 6072180201 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/28/2009 | ||||||||
| LastUpdateDate: | 05/28/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | 005146 | NY | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
ID Information
| ID | Type | State | Issuer | Description | 04800005146 | 05 | NY | MEDICAID |