Healthcare Provider Details

I. General information

NPI: 1154758969
Provider Name (Legal Business Name): LAUREN MINCHEN NUTRITION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2013
Last Update Date: 10/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

280 MADISON AVE RM 806
NEW YORK NY
10016-0805
US

IV. Provider business mailing address

280 MADISON AVE RM 806
NEW YORK NY
10016-0805
US

V. Phone/Fax

Practice location:
  • Phone: 646-745-7034
  • Fax:
Mailing address:
  • Phone: 646-745-7034
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number007792-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number1049273
License Number StateNY

VIII. Authorized Official

Name: MRS. LAUREN ASHLEY MINCHEN
Title or Position: REGISTERED DIETITIAN
Credential: RD, CDN
Phone: 646-745-7034