Healthcare Provider Details

I. General information

NPI: 1982148052
Provider Name (Legal Business Name): BALANCE DIETETICS-NUTRITION & PSYCHOLOGICAL EATING DISORDER PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2016
Last Update Date: 12/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 W 27TH ST FL 7
NEW YORK NY
10001-6240
US

IV. Provider business mailing address

112 W 27TH ST FL 7
NEW YORK NY
10001-6240
US

V. Phone/Fax

Practice location:
  • Phone: 212-645-6903
  • Fax:
Mailing address:
  • Phone: 212-645-6903
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MS. MELAINIE ROGERS
Title or Position: FOUNDER AND EXECUTIVE DIRECTOR
Credential: MS, RDN, CEDRD
Phone: 212-645-6903