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General NPI Number Information
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NPI Number | 1114308459
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Entity Type | Organization
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Legal Business Name | M. RENDA, RD, CDN
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Dates
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Enumeration Date | 06/12/2015
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Last Update Date | 06/12/2015
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Provider Practice Location Address
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Address Line | 2415 JERUSALEM AVE SUITE 106
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City | NORTH BELLMORE
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State | NY
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Zip | 11710-1870
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Country | US
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Telephone | 516-672-5927
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Fax |
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Provider Business Mailing Address
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Address Line | 7 PARK LN
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City | LEVITTOWN
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State | NY
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Zip | 11756-1115
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Country | US
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Telephone | 516-672-5927
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Fax |
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Authorized Official
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Title or Position | REGISTERED DIETITIAN, CDN
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Name | MRS. MARION RENDA
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Credential | R.D., CDN
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Telephone | 516-672-5927
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | 005185-1
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License Number State | NY
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