Healthcare Provider Details

I. General information

NPI: 1245507367
Provider Name (Legal Business Name): MARIA ELENA FRAGA RD,CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/17/2011
Last Update Date: 01/04/2022
Certification Date: 01/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 GUSTAVE L LEVY PL
NEW YORK NY
10029-6500
US

IV. Provider business mailing address

1 GUSTAVE L.LEVY PLACE BOX 3000
NEW YORK NY
10029
US

V. Phone/Fax

Practice location:
  • Phone: 212-241-6071
  • Fax:
Mailing address:
  • Phone: 212-987-3100
  • Fax: 212-731-5210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License Number001277
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: