Healthcare Provider Details

I. General information

NPI: 1720042005
Provider Name (Legal Business Name): JOYCE SAVOY RD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 MERRICK RD
MERRICK NY
11566-4542
US

IV. Provider business mailing address

131 MERRICK RD
MERRICK NY
11566-4542
US

V. Phone/Fax

Practice location:
  • Phone: 516-223-1515
  • Fax: 516-223-8205
Mailing address:
  • Phone: 516-223-1515
  • Fax: 516-223-8205

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License Number000154
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: