Healthcare Provider Details

I. General information

NPI: 1558510420
Provider Name (Legal Business Name): CLAIRE ANITA ESSON-SAMUELS RD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2008
Last Update Date: 09/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18410 JAMAICA AVE LIFESPIRE INC
HOLLIS NY
11423-2400
US

IV. Provider business mailing address

920 CO OP CITY BLVD APT 2J
BRONX NY
10475-1648
US

V. Phone/Fax

Practice location:
  • Phone: 516-455-1941
  • Fax:
Mailing address:
  • Phone: 718-671-0278
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number0060861
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number894124
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: