Basic Information
| Provider Information | |||||||||
| NPI: | 1689811424 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCMULLIN | ||||||||
| FirstName: | MAUREEN | ||||||||
| MiddleName: | ELLEN | ||||||||
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| Credential: | MS, RD, CD-N | ||||||||
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| Mailing Information | |||||||||
| Address1: | 391 ATLANTIC AVE | ||||||||
| Address2: | |||||||||
| City: | STATEN ISLAND | ||||||||
| State: | NY | ||||||||
| PostalCode: | 103052335 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7186681824 | ||||||||
| FaxNumber: | 7182897833 | ||||||||
| Practice Location | |||||||||
| Address1: | 2534 STEINWAY ST | ||||||||
| Address2: | |||||||||
| City: | ASTORIA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 111033702 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7187775243 | ||||||||
| FaxNumber: | 7187775250 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/15/2009 | ||||||||
| LastUpdateDate: | 01/15/2009 | ||||||||
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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 | 003528-1 | NY | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.