Provider Demographics
NPI:1699292318
Name:FOTI, CARLY LAURAINE (RD, CDN)
Entity type:Individual
Prefix:
First Name:CARLY
Middle Name:LAURAINE
Last Name:FOTI
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 1:37C LAKEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:HALFMOON
Mailing Address - State:NY
Mailing Address - Zip Code:12065-4126
Mailing Address - Country:US
Mailing Address - Phone:315-778-2546
Mailing Address - Fax:
Practice Address - Street 1:37C LAKEVIEW DR
Practice Address - Street 2:
Practice Address - City:HALFMOON
Practice Address - State:NY
Practice Address - Zip Code:12065-4126
Practice Address - Country:US
Practice Address - Phone:315-778-2546
Practice Address - Fax:315-778-2546
Is Sole Proprietor?:No
Enumeration Date:2017-08-23
Last Update Date:2017-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY86011156133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered