Healthcare Provider Details

I. General information

NPI: 1326033606
Provider Name (Legal Business Name): LESLIE ANN SEIDEN MS,RD,CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2005
Last Update Date: 07/22/2010
Certification Date:
Deactivation Date: 03/22/2006
Reactivation Date: 03/27/2006

III. Provider practice location address

7318 167TH ST
FLUSHING NY
11366-1325
US

IV. Provider business mailing address

7318 167TH ST
FLUSHING NY
11366-1325
US

V. Phone/Fax

Practice location:
  • Phone: 718-969-7266
  • Fax: 718-969-7266
Mailing address:
  • Phone: 718-969-7266
  • Fax: 718-969-7266

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number000124
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: