Marlo Nanci Mittler, MS RD

Primary specialty

Pediatric Nutrition Registered DietitianTaxonomy code 133VN1004X

License

819264 Issued in IL

Practice address

173 E Shore Rd
Great Neck, NY 11023-2456

Phone

(516) 857-6465

NPI assigned

Jul 19, 2021

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1626652800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1626652800000",
    "number": "1194398156",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5 COLONIAL DR",
            "city": "SMITHTOWN",
            "state": "NY",
            "postal_code": "117874212",
            "telephone_number": "516-857-6465"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "173 E SHORE RD",
            "city": "GREAT NECK",
            "state": "NY",
            "postal_code": "110232456",
            "telephone_number": "516-857-6465"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5 Colonial Dr",
            "address_purpose": "LOCATION",
            "city": "Smithtown",
            "state": "NY",
            "postal_code": "117874212",
            "country_code": "US",
            "telephone_number": "516-857-6465",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MITTLER",
        "first_name": "MARLO",
        "middle_name": "NANCI",
        "credential": "MS RD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-07-19",
        "last_updated": "2021-07-19",
        "certification_date": "2021-07-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "NY",
            "license": "819264",
            "primary": false
        },
        {
            "code": "133VN1004X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered, Nutrition, Pediatric",
            "state": "NY",
            "license": "819264",
            "primary": false
        },
        {
            "code": "133VN1004X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered, Nutrition, Pediatric",
            "state": "IL",
            "license": "819264",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "info@nutritionbymarlo.com",
            "affiliation": "N",
            "endpointDescription": "email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "5 Colonial Dr",
            "city": "Smithtown",
            "state": "NY",
            "country_code": "US",
            "postal_code": "117874212",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Pediatric Nutrition Registered Dietitian in Great Neck, NY
• Providers in Great Neck, NY by specialty
• Pediatric Nutrition Registered Dietitian in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.