Provider Demographics
NPI:1184048571
Name:RATLIFF, MAEGAN DANIELLE (RD, CDN, LMT)
Entity type:Individual
Prefix:
First Name:MAEGAN
Middle Name:DANIELLE
Last Name:RATLIFF
Suffix:
Gender:F
Credentials:RD, CDN, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3421 41ST ST APT 2L
Mailing Address - Street 2:
Mailing Address - City:LONG ISLAND CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11101-1388
Mailing Address - Country:US
Mailing Address - Phone:914-656-3094
Mailing Address - Fax:
Practice Address - Street 1:154 W 70TH ST APT 9N
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-4497
Practice Address - Country:US
Practice Address - Phone:914-656-3094
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-06
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1023268133V00000X
NY007985133V00000X
NY031340225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00695941Medicaid
NY331943Medicare Oscar/Certification
NYG100000410Medicare Oscar/Certification
NYW6L111Medicare Oscar/Certification
NY331952Medicare Oscar/Certification