Healthcare Provider Details

I. General information

NPI: 1437652369
Provider Name (Legal Business Name): PARVANEH GOLBARI INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2018
Last Update Date: 05/23/2022
Certification Date: 05/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6902 AUSTIN ST FL 2
FOREST HILLS NY
11375-4250
US

IV. Provider business mailing address

47 STEPPING STONE LN
GREAT NECK NY
11024-1313
US

V. Phone/Fax

Practice location:
  • Phone: 516-330-3970
  • Fax: 516-482-3473
Mailing address:
  • Phone: 516-330-3970
  • Fax: 516-482-3473

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number943609
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number006441-1
License Number State

VIII. Authorized Official

Name: PARVANEH GOLBARI
Title or Position: REGISTERED DIETITIAN/NUTRITIONIST
Credential: RD, CDN
Phone: 516-330-3970