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General NPI Number Information
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NPI Number | 1003451576
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Entity Type | Organization
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Legal Business Name | BERTA NUTRITION LLC
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Dates
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Enumeration Date | 11/08/2019
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Last Update Date | 11/08/2019
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Provider Practice Location Address
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Address Line | 74A PARKWAY CT
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City | BROOKLYN
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State | NY
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Zip | 11235-6113
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Country | US
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Telephone | 732-508-0347
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Fax |
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Provider Business Mailing Address
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Address Line | 724 AVENUE W
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City | BROOKLYN
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State | NY
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Zip | 11223-5549
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PROVIDER
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Name | BERTA YATCHA
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Credential | RD
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Telephone | 347-323-7025
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number |
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License Number State |
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