Healthcare Provider Details

I. General information

NPI: 1730636572
Provider Name (Legal Business Name): VANESSA BERENSTEIN MA, RDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2016
Last Update Date: 09/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6829 ELM ST STE 300
MC LEAN VA
22101-3845
US

IV. Provider business mailing address

15 CENTRAL PARK W APT 16G
NEW YORK NY
10023-7715
US

V. Phone/Fax

Practice location:
  • Phone: 703-532-4892
  • Fax:
Mailing address:
  • Phone: 646-535-2742
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86035651
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: