Healthcare Provider Details

I. General information

NPI: 1720393051
Provider Name (Legal Business Name): SUSAN BRENDA TREE CDR, RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2010
Last Update Date: 08/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1110 EASTERN PKWY
BROOKLYN NY
11213-4845
US

IV. Provider business mailing address

585 SCHENECTADY AVENUE
BROOKLYN NY
11203-1891
US

V. Phone/Fax

Practice location:
  • Phone: 718-735-1900
  • Fax:
Mailing address:
  • Phone: 718-604-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number000844
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: