MEDICARE: RABIA A ALI RDN

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	133VN1004X	Pediatric Nutrition Registered Dietitian	86169460	NY

General Provider Information

NPI Number	:	1609563220
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RABIA A ALI RDN

Provider Business Mailing Address
First Line	:	2454-2460 HYLAN BLVD
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10306
Country	:	US
Telephone Number	:	347-613-0729
Fax Number	:

Provider Business Practice Location Address
First Line	:	61 SPEEDWELL AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10314-3261
Country	:	US
Telephone Number	:	347-613-0729
Fax Number	:

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

Provider Enumeration Date	:	04/24/2023
Last Update Date	:	04/24/2023

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