Healthcare Provider Details

I. General information

NPI: 1053640920
Provider Name (Legal Business Name): CHAYA SARA EBERSTARK R.D. CDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/23/2009
Last Update Date: 01/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 LINWOOD AVE
CEDARHURST NY
11516-1720
US

IV. Provider business mailing address

304 LINWOOD AVE
CEDARHURST NY
11516-1720
US

V. Phone/Fax

Practice location:
  • Phone: 917-612-3373
  • Fax:
Mailing address:
  • Phone: 917-612-3373
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1022512
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: