Provider Demographics
NPI:1487370409
Name:MOTTE DIT FALISSE, CAMILLE (RD)
Entity type:Individual
Prefix:
First Name:CAMILLE
Middle Name:
Last Name:MOTTE DIT FALISSE
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:CAMILLE
Other - Middle Name:
Other - Last Name:FALISSE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RD
Mailing Address - Street 1:305 E 95TH ST APT 6D
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-5776
Mailing Address - Country:US
Mailing Address - Phone:703-975-6302
Mailing Address - Fax:
Practice Address - Street 1:305 E 95TH ST APT 6D
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-5776
Practice Address - Country:US
Practice Address - Phone:703-975-6302
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-12
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY86169929133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered