Shane Fit

Primary specialty

Dietary ManagerTaxonomy code 132700000X

License

R049213-1 Issued in NY

Legal business name

SHANE FIT

Practice address

134 Teatown Road
Croton on Hudson, CA 90265

Phone

(626) 797-9977

NPI assigned

Apr 16, 2012

Organization subpart

No

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

Authorized official

Name

Mrs. Michelle Maidenberg, M.D.

Title

Medical Doctor

Phone

(626) 797-9977

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1334534400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1334534400000",
    "number": "1295092229",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "134 TEATOWN RD",
            "city": "CROTON ON HUDSON",
            "state": "NY",
            "postal_code": "105203524",
            "telephone_number": "626-797-9977"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "134 TEATOWN ROAD",
            "city": "CROTON ON HUDSON",
            "state": "CA",
            "postal_code": "90265",
            "telephone_number": "626-797-9977"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHANE FIT",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-04-16",
        "last_updated": "2012-04-16",
        "status": "A",
        "authorized_official_last_name": "MAIDENBERG",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_title_or_position": "MEDICAL DOCTOR",
        "authorized_official_telephone_number": "626-797-9977",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "132700000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dietary Manager",
            "state": "NY",
            "license": "R049213-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 16, 2012; 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.