Dietitians of Northern New York, PLLC.

Primary specialty

Registered DietitianTaxonomy code 133V00000X

Legal business name

DIETITIANS OF NORTHERN NEW YORK, PLLC.

Doing business as

Dietitians of Northern New York

Practice address

415 Sherman St
Watertown, NY 13601-3920

Phone

(315) 221-4881

Fax

(315) 777-4111

NPI assigned

Jun 16, 2021

Organization subpart

No

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

Authorized official

Name

Etosha Farmer, MS, RDN, CDCESNPI 1144518499

Title

Owner

Phone

(315) 221-4881

Specialties & licenses 1

Addresses

Other names 1

• Dietitians of Northern New York Doing business as

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Etosha Farmer, MS, RDN, CDCES

  • Registered Dietitian
  • Watertown, NY
  • NPI 1144518499

  Dietitian, Registered

  Medicare reassignment Care Compare group NPD Authorized official
• Laura Jean McManus, MA, RDN, CDN, CLC

  • Registered Dietitian
  • Marcellus, NY
  • NPI 1881186468

  Dietitian, Registered

  Medicare reassignment Care Compare group NPD
• Amanda Lyn Woolnough, RDN

  • Registered Dietitian
  • Watertown, NY
  • NPI 1760126627

  Dietitian, Registered

  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1623801600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1668988800000",
    "number": "1316515208",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "415 SHERMAN ST",
            "city": "WATERTOWN",
            "state": "NY",
            "postal_code": "136013920",
            "telephone_number": "315-221-4881",
            "fax_number": "315-777-4111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "415 SHERMAN ST",
            "city": "WATERTOWN",
            "state": "NY",
            "postal_code": "136013920",
            "telephone_number": "315-221-4881",
            "fax_number": "315-777-4111"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5402 Dayan St",
            "address_purpose": "LOCATION",
            "city": "Lowville",
            "state": "NY",
            "postal_code": "133671100",
            "country_code": "US",
            "telephone_number": "315-221-4881",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "DIETITIANS OF NORTHERN NEW YORK, PLLC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-06-16",
        "last_updated": "2022-11-21",
        "certification_date": "2022-11-21",
        "status": "A",
        "authorized_official_last_name": "FARMER",
        "authorized_official_first_name": "ETOSHA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "315-221-4881",
        "authorized_official_credential": "MS, RDN, CDCES"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dietitian, Registered",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dietitians of Northern New York",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Dietitians of Northern New York",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Natalie Diaz
• Leon Lansing Dickinson
• Sarah R Dickinson
• Linda Diehl
• Dietitians of Northern New York
• Adrienne Kelly Dietrich, M.S., ED.
• Margaret Rita Dillabough
• Maria Elena Dille, DDS
• Kimberly Michelle Dinan, OTR/L
• Bruce James Dines, DMD

• Registered Dietitian in Watertown, NY
• Providers in Watertown, NY by specialty
• Registered Dietitian in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2022; 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.