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General NPI Number Information
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NPI Number | 1407096506
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Entity Type | Organization
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Legal Business Name | YOUR HEALTH YOUR CHOICE DIETETICS AND NUTRITION PLLC
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Dates
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Enumeration Date | 03/02/2009
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Last Update Date | 02/22/2013
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Provider Practice Location Address
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Address Line | 436 HINSDALE RD
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City | CAMILLUS
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State | NY
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Zip | 13031-1648
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Country | US
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Telephone | 315-345-6803
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Fax | 315-672-3009
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Provider Business Mailing Address
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Address Line | PO BOX 216
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City | CAMILLUS
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State | NY
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Zip | 13031-0216
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Country | US
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Telephone | 315-345-6803
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Fax | 315-672-3009
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Authorized Official
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Title or Position | RD
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Name | MRS. REBECCA E BOYEA-KERTESZ
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Credential | RD
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Telephone | 315-345-6803
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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 | 005578
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License Number State | NY
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