Provider Demographics
NPI:1922214329
Name:MCILHENNY, ANNE E (MS, RD, CDE)
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:E
Last Name:MCILHENNY
Suffix:
Gender:F
Credentials:MS, RD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 PARK ST
Mailing Address - Street 2:
Mailing Address - City:MALONE
Mailing Address - State:NY
Mailing Address - Zip Code:12953-1220
Mailing Address - Country:US
Mailing Address - Phone:518-483-3000
Mailing Address - Fax:518-481-2695
Practice Address - Street 1:133 PARK ST
Practice Address - Street 2:
Practice Address - City:MALONE
Practice Address - State:NY
Practice Address - Zip Code:12953-1220
Practice Address - Country:US
Practice Address - Phone:518-483-3000
Practice Address - Fax:518-481-2695
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2008-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002528-1133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYDD0114OtherALICE HYDE MEDICAL CENTER
00832652OtherAMERICAN DIETETIC ASSN #
NY002528-1OtherNYS REGISTRATION CERTIFIC