Healthcare Provider Details

I. General information

NPI: 1740584044
Provider Name (Legal Business Name): SUSAN LEVY R.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2010
Last Update Date: 12/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

558 WESTCHESTER AVE
RYE BROOK NY
10573-2815
US

IV. Provider business mailing address

588 WESTCHESTER AVENUE
RYE BROOK NY
10573
US

V. Phone/Fax

Practice location:
  • Phone: 914-935-0123
  • Fax: 866-293-4500
Mailing address:
  • Phone: 914-935-0123
  • Fax: 866-293-4500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number003359
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: