Provider Demographics
NPI:1023308624
Name:AIKEN, DOROTHY E
Entity type:Individual
Prefix:MRS
First Name:DOROTHY
Middle Name:E
Last Name:AIKEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 WILBUR RD
Mailing Address - Street 2:NYS HVDDSO OPWDD
Mailing Address - City:THIELLS
Mailing Address - State:NY
Mailing Address - Zip Code:10984-7555
Mailing Address - Country:US
Mailing Address - Phone:845-947-6220
Mailing Address - Fax:845-947-6240
Practice Address - Street 1:11 WILBUR RD
Practice Address - Street 2:NYS HVDDSO OPWDD
Practice Address - City:THIELLS
Practice Address - State:NY
Practice Address - Zip Code:10984-7555
Practice Address - Country:US
Practice Address - Phone:845-947-6220
Practice Address - Fax:845-947-6240
Is Sole Proprietor?:No
Enumeration Date:2011-04-15
Last Update Date:2011-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0046661133N00000X
NY852266133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist