MEDICARE: THE CENTER FOR CANCER LIFESTYLE MANAGEMENT

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	133VN1006X	Metabolic Nutrition Registered Dietitian
2	133VN1301X	Oncology Nutrition Registered Dietitian
3	103TC1900X	Counseling Psychologist
4	1041C0700X	Clinical Social Worker
5	133N00000X	Nutritionist
6	133NN1002X	Nutrition Education Nutritionist
7	133V00000X	Registered Dietitian
8	261QM1300X	Multi-Specialty Clinic/Center

General Provider Information

NPI Number	:	1578256574
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE CENTER FOR CANCER LIFESTYLE MANAGEMENT

Provider Business Mailing Address
First Line	:	308 W 97TH ST APT 4
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10025-6123
Country	:	US
Telephone Number	:	917-450-4625
Fax Number	:

Provider Business Practice Location Address
First Line	:	308 W 97TH ST APT 4
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10025-6123
Country	:	US
Telephone Number	:	917-450-4625
Fax Number	:

Authorized Official
Title or Position	:	FOUNDER AND EXECUTIVE DIRECTOR
Name	:	DR. CINDY D NESS
Credential	:	PHD
Telephone Number	:	917-450-4625

Provider Enumeration Date	:	05/26/2023
Last Update Date	:	05/26/2023

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