Healthcare Provider Details

I. General information

NPI: 1831788769
Provider Name (Legal Business Name): BRITTANY L BERGER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2021
Last Update Date: 01/14/2021
Certification Date: 01/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3610 MYSTIC VALLEY PKWY APT N1411
MEDFORD MA
02155-5753
US

IV. Provider business mailing address

3610 MYSTIC VALLEY PKWY APT N1411
MEDFORD MA
02155-5753
US

V. Phone/Fax

Practice location:
  • Phone: 914-497-6939
  • Fax:
Mailing address:
  • Phone: 914-497-6939
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name: MS. BRITTANY BERGER
Title or Position: REGISTERED DIETITIAN/ OWNER
Credential: MS, RD, LDN
Phone: 914-497-6939