Healthcare Provider Details

I. General information

NPI: 1194941591
Provider Name (Legal Business Name): BONNIE RENEE GILLER MS, RD, CDN, CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

383 PLYMOUTH ST
WEST HEMPSTEAD NY
11552-2450
US

IV. Provider business mailing address

383 PLYMOUTH ST
WEST HEMPSTEAD NY
11552-2450
US

V. Phone/Fax

Practice location:
  • Phone: 516-486-4569
  • Fax: 516-486-1792
Mailing address:
  • Phone: 516-486-4569
  • Fax: 516-486-1792

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number000251
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: