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General NPI Number Information
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NPI Number | 1679559561
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Entity Type | Individual
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Provider Name | ANGELA BENCIVENGO MPH RD CDN
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Gender | Female
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Dates
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Enumeration Date | 12/21/2005
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Last Update Date | 01/17/2021
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Provider Practice Location Address
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Address Line | 210 WESTCHESTER AVE
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City | WHITE PLAINS
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State | NY
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Zip | 10604-2901
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Country | US
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Telephone | 914-831-4154
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Fax | 914-457-1526
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Provider Business Mailing Address
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Address Line | 800 WESTCHESTER AVE STE N715
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City | RYE BROOK
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State | NY
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Zip | 10573-1376
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Country | US
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Telephone | 914-607-5730
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 005178-1
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License Number State | NY
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