MEDICARE: ENJOY FOOD. ENJOY LIFE.

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	:	1417521956
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ENJOY FOOD. ENJOY LIFE.

Provider Business Mailing Address
First Line	:	185 W PARK AVE APT 208
Second Line	:
City	:	LONG BEACH
State	:	NY
Zip	:	11561-3328
Country	:	US
Telephone Number	:	212-729-0327
Fax Number	:

Provider Business Practice Location Address
First Line	:	185 W PARK AVE APT 208
Second Line	:
City	:	LONG BEACH
State	:	NY
Zip	:	11561-3328
Country	:	US
Telephone Number	:	212-729-0327
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. NICOLE RODRIGUEZ
Credential	:	RDN
Telephone Number	:	212-729-0327

Provider Enumeration Date	:	05/19/2021
Last Update Date	:	05/19/2021

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