Provider Demographics
NPI:1962537274
Name:MARILYN TUCKER VISELLI MS RD CDN INC
Entity type:Organization
Organization Name:MARILYN TUCKER VISELLI MS RD CDN INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARILYN
Authorized Official - Middle Name:
Authorized Official - Last Name:TUCKER VISELLI
Authorized Official - Suffix:
Authorized Official - Credentials:MS RD CDN
Authorized Official - Phone:914-282-6801
Mailing Address - Street 1:140 LOCKWOOD AVE
Mailing Address - Street 2:SUITE 107
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10801
Mailing Address - Country:US
Mailing Address - Phone:914-632-1896
Mailing Address - Fax:914-632-4284
Practice Address - Street 1:140 LOCKWOOD AVE
Practice Address - Street 2:SUITE 107
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10801
Practice Address - Country:US
Practice Address - Phone:914-632-1896
Practice Address - Fax:914-632-4284
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0007832133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
S00432Medicare ID - Type Unspecified
S00431Medicare ID - Type Unspecified
P49065Medicare UPIN