Individual provider Active NPI

Marylou Plante

  • Registered Dietitian
  • Syracuse, NY
National Provider Identifier
1215304381
Registry record updated Aug 25, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered DietitianTaxonomy code 133V00000X
License
004484-1 Issued in NY
Practice address
4601 Nixon Park Dr
Syracuse, NY 13215-9759
Phone
(315) 449-6923
NPI assigned
Aug 25, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 25, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Dietitian 133V00000X 004484-1 NY Primary

Addresses

Primary practice location

4601 Nixon Park Dr
Syracuse, NY 13215-9759

Mailing address

4601 Nixon Park Dr
Syracuse, NY 13215-9759

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190529001850 NY Practitioner - Registered Dietitian Or Nutrition Professional 1759624059 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
004484-1NYMDRegistered Dietitian

Practice roles

OrganizationSpecialtyStatusNew patients
Monroe Ddso Clinic Pittsford CurrentSince May 31, 2025 Accepting new patients
State of New York Comptrollers Office Past Accepting new patients

Locations

44 Holland Ave
Fl 4
Albany, NY 12208

305 Main St
Binghamton, NY 13905
Phone (607) 729-1295

6007 Fair Lakes Rd
Ste 400
East Syracuse, NY 13057
Phone (315) 234-5730

200 W Dominick St
Rome, NY 13440
Phone (315) 339-6536

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1440460800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1440460800000",
    "number": "1215304381",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4601 NIXON PARK DR",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132159759"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4601 NIXON PARK DR",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132159759",
            "telephone_number": "315-449-6923"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PLANTE",
        "first_name": "MARYLOU",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-08-25",
        "last_updated": "2015-08-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "NY",
            "license": "004484-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Syracuse, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.