Healthcare Provider Details

I. General information

NPI: 1083795090
Provider Name (Legal Business Name): ALINA BYSTRIK RD, CDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 OCEANA DR W SUITE 3F
BROOKLYN NY
11235-6656
US

IV. Provider business mailing address

150 OCEANA DR W SUITE 3F
BROOKLYN NY
11235-6656
US

V. Phone/Fax

Practice location:
  • Phone: 718-687-3102
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number005455
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: