MEDICARE: FOOD SMART DIETETICS PC

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1750725081	OTHER		INDIVIDUAL NPI

General Provider Information

NPI Number	:	1427473677
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOOD SMART DIETETICS PC

Provider Business Mailing Address
First Line	:	2073 E 9TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11223-4130
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2073 E 9TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11223-4130
Country	:	US
Telephone Number	:	917-741-5418
Fax Number	:

Authorized Official
Title or Position	:	PROVIDER
Name	:	CLAUDIA CHOMALI
Credential	:
Telephone Number	:	917-741-5418

Provider Enumeration Date	:	02/25/2014
Last Update Date	:	02/25/2014

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