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General NPI Number Information
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NPI Number | 1053486407
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Entity Type | Organization
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Legal Business Name | BRG DIETETICS & NUTRITION, P.C.
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Dates
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Enumeration Date | 11/21/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 383 PLYMOUTH ST
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City | WEST HEMPSTEAD
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State | NY
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Zip | 11552-2450
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Country | US
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Telephone | 516-486-4569
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Fax | 516-486-1792
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Provider Business Mailing Address
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Address Line | 383 PLYMOUTH ST
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City | WEST HEMPSTEAD
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State | NY
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Zip | 11552-2450
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Country | US
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Telephone | 516-486-4569
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Fax | 516-486-1792
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Authorized Official
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Title or Position | PRESIDENT REGISTERED DIETITIAN
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Name | MRS. BONNIE RENEE GILLER
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Credential | MS, RD, CDN, CDE
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Telephone | 516-486-4569
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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 | 000251
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License Number State | NY
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