Healthcare Provider Details

I. General information

NPI: 1215261060
Provider Name (Legal Business Name): HELEN GLORIA NGOZI EGERUOH RD, CDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2009
Last Update Date: 09/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 OCEAN PKWY CONEY ISLAND HOSPITAL , FOOD & NUTRITION SERVICES
BROOKLYN NY
11235-7745
US

IV. Provider business mailing address

2601 OCEAN PKWY CONEY ISLAND HOSPITAL , FOOD & NUTRITION SERVICES
BROOKLYN NY
11235-7745
US

V. Phone/Fax

Practice location:
  • Phone: 718-616-4183
  • Fax: 718-616-4791
Mailing address:
  • Phone: 718-616-4183
  • Fax: 718-616-4791

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number002363-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number862502
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: