Healthcare Provider Details

I. General information

NPI: 1477355816
Provider Name (Legal Business Name): RACHEL BLUMBERG RD, CDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2025
Last Update Date: 03/26/2025
Certification Date: 03/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 MARCUS AVE STE M15
NEW HYDE PARK NY
11042-1034
US

IV. Provider business mailing address

34 YALE AVE
HEWLETT NY
11557-1528
US

V. Phone/Fax

Practice location:
  • Phone: 516-601-7200
  • Fax:
Mailing address:
  • Phone: 347-233-1844
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: