Active NPI
Stephen Wickes, RD, CDN
- Registered Dietitian
- Greenvale, NY
National Provider Identifier
1366254658
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 012331-01
- Practice address
- 340 Wheatley PLZ Ste B
Greenvale, NY 11548-1339 - Phone
- (516) 351-2350
- NPI assigned
- Jan 23, 2025
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 012331-01 | NY | Primary |
Addresses
Primary practice location
340 Wheatley PLZ Ste B
Greenvale, NY 11548-1339
Mailing address
340 Wheatley PLZ Ste B
Greenvale, NY 11548-1339
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 012331-01 | NY | MD | Registered Dietitian |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| One Sound Body Inc | Current | Accepting new patients | |
| Nourish, Inc. | Dietitian, Registered | Past | Accepting new patients |
Locations
340 Wheatley Plz
Ste B
Greenvale, NY 11548
Phone (516) 351-2350
Organizations & group practices 2
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.
-
- Clinic/Center
- Greenvale, NY
- NPI 1861204166
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1737590400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1737590400000",
"number": "1366254658",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "340 WHEATLEY PLZ STE B",
"city": "GREENVALE",
"state": "NY",
"postal_code": "115481339"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "340 WHEATLEY PLZ STE B",
"city": "GREENVALE",
"state": "NY",
"postal_code": "115481339",
"telephone_number": "516-351-2350"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WICKES",
"first_name": "STEPHEN",
"credential": "RD, CDN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2025-01-23",
"last_updated": "2025-01-23",
"certification_date": "2025-01-23",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "NY",
"license": "012331-01",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Greenvale, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.