Healthcare Provider Details

I. General information

NPI: 1922086214
Provider Name (Legal Business Name): MINDY H ROSENTHAL C.N., R.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/06/2006
Last Update Date: 06/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7030 173RD ST
FLUSHING NY
11365-3450
US

IV. Provider business mailing address

7030 173RD ST
FLUSHING NY
11365-3450
US

V. Phone/Fax

Practice location:
  • Phone: 718-591-6321
  • Fax: 718-591-6321
Mailing address:
  • Phone: 718-591-6321
  • Fax: 718-591-6321

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number000745
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number716993
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: