Basic Information
| Provider Information | |||||||||
| NPI: | 1437469327 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DISANTO | ||||||||
| FirstName: | CLARE | ||||||||
| MiddleName: | S | ||||||||
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| Credential: | RD,CDN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 711 TROY SCHENECTADY RD STE 203 | ||||||||
| Address2: | |||||||||
| City: | LATHAM | ||||||||
| State: | NY | ||||||||
| PostalCode: | 121102461 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5187823700 | ||||||||
| FaxNumber: | 5187823799 | ||||||||
| Practice Location | |||||||||
| Address1: | 501 NEW KARNER RD | ||||||||
| Address2: | SUITE 1A | ||||||||
| City: | ALBANY | ||||||||
| State: | NY | ||||||||
| PostalCode: | 122053882 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5184521337 | ||||||||
| FaxNumber: | 5187246660 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/14/2010 | ||||||||
| LastUpdateDate: | 01/26/2018 | ||||||||
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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 | 006935 | NY | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
ID Information
| ID | Type | State | Issuer | Description | 069DF1 | 01 | NY | EMPIRE BLUECROSS BLUESHIELD | OTHER | 9695604 | 01 | NY | AETNA | OTHER | 101220000058 | 01 | NY | FIDELIS CARE NY | OTHER | 644108 | 01 | NY | GHI/HMO | OTHER |