Healthcare Provider Details

I. General information

NPI: 1538569363
Provider Name (Legal Business Name): EVA LEDEZMA M.S., R.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2014
Last Update Date: 08/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 E 95TH ST
NEW YORK NY
10128-4077
US

IV. Provider business mailing address

1000 ZECKENDORF BLVD
GARDEN CITY NY
11530-2133
US

V. Phone/Fax

Practice location:
  • Phone: 212-996-8000
  • Fax: 212-423-3127
Mailing address:
  • Phone: 516-542-6880
  • Fax: 516-542-5556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number008139
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: