Healthcare Provider Details

I. General information

NPI: 1922769165
Provider Name (Legal Business Name): ERICA LEON NUTRITION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2022
Last Update Date: 09/14/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 S BROADWAY FL 4
WHITE PLAINS NY
10601-4413
US

IV. Provider business mailing address

9 SPRINGWOOD AVE
ARDSLEY NY
10502-2506
US

V. Phone/Fax

Practice location:
  • Phone: 914-693-2174
  • Fax: 833-641-2564
Mailing address:
  • Phone: 914-693-2174
  • Fax: 833-641-2564

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name: MICHELE RAMOS
Title or Position: CREDENTIALING COORDINATOR
Credential:
Phone: 203-828-0028