Healthcare Provider Details

I. General information

NPI: 1891361333
Provider Name (Legal Business Name): BETH WARREN NUTRITION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2021
Last Update Date: 06/03/2021
Certification Date: 06/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1551 EAST 4TH STREET
BROOKLYN NY
11230
US

IV. Provider business mailing address

1551 EAST 4TH STREET
BROOKLYN NY
11230
US

V. Phone/Fax

Practice location:
  • Phone: 347-292-1725
  • Fax: 212-202-6025
Mailing address:
  • Phone: 347-292-1725
  • Fax: 212-202-6025

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. BETH ALLISON WARREN
Title or Position: MS RD CDN, CEO
Credential:
Phone: 347-292-1725