Healthcare Provider Details

I. General information

NPI: 1467636241
Provider Name (Legal Business Name): CYNTHIA R RUBINOFF-MYERS MS, RD, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/28/2007
Last Update Date: 12/28/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 GERRY AVE
SOUTH PORTLAND ME
04106-6103
US

IV. Provider business mailing address

10 GERRY AVE
SOUTH PORTLAND ME
04106-6103
US

V. Phone/Fax

Practice location:
  • Phone: 207-828-1618
  • Fax: 207-828-1618
Mailing address:
  • Phone: 207-828-1618
  • Fax: 207-828-1618

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License NumberD1229
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: