Provider Demographics
NPI:1285692491
Name:PIETROCARLO, DIANE EHLE (RD, CDN)
Entity type:Individual
Prefix:MS
First Name:DIANE
Middle Name:EHLE
Last Name:PIETROCARLO
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 1:400 RECTOR RD
Mailing Address - Street 2:
Mailing Address - City:GLENVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12302-6702
Mailing Address - Country:US
Mailing Address - Phone:518-374-6424
Mailing Address - Fax:
Practice Address - Street 1:9 GLEASON RD
Practice Address - Street 2:PROFESSIONAL BUILDING
Practice Address - City:GLENVILLE
Practice Address - State:NY
Practice Address - Zip Code:12302-5307
Practice Address - Country:US
Practice Address - Phone:518-384-0562
Practice Address - Fax:518-384-0562
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-04
Last Update Date:2007-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY535353133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered