MEDICARE: EAT DRINK AND BE HEALTHY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian

General Provider Information

NPI Number	:	1154840031
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EAT DRINK AND BE HEALTHY LLC

Provider Business Mailing Address
First Line	:	353 E 72ND ST APT 31C
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10021-4622
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	353 E 72ND ST APT 31C
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10021-4622
Country	:	US
Telephone Number	:	845-642-8023
Fax Number	:

Authorized Official
Title or Position	:	DIETITIAN/OWNER
Name	:	JORDANA TURKEL
Credential	:
Telephone Number	:	845-642-8023

Provider Enumeration Date	:	09/12/2017
Last Update Date	:	11/21/2017

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