MEDICARE: REGINA NG RDN, CDN, MS

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	011058	NY

General Provider Information

NPI Number	:	1568165215
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REGINA NG RDN, CDN, MS

Provider Business Mailing Address
First Line	:	204 WAKEMAN PL
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11220-4832
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	204 WAKEMAN PL
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11220-4832
Country	:	US
Telephone Number	:	718-312-2675
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/22/2023
Last Update Date	:	03/22/2023

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