Healthcare Provider Details

I. General information

NPI: 1235439357
Provider Name (Legal Business Name): INNOCENTIA GIDI C.D.N
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/22/2010
Last Update Date: 10/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 GRAND CONCOURSE
BRONX NY
10457
US

IV. Provider business mailing address

1601 METROPOLITAN AVE 3C
BRONX NY
10462
US

V. Phone/Fax

Practice location:
  • Phone: 718-518-5290
  • Fax:
Mailing address:
  • Phone: 347-263-6372
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number005120
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: