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General NPI Number Information
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NPI Number | 1821511262
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Entity Type | Organization
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Legal Business Name | BORO PARK NUTRITION, LLC
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Dates
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Enumeration Date | 07/18/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 1662 47TH ST
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City | BROOKLYN
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State | NY
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Zip | 11204-1141
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Country | US
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Telephone | 347-746-0453
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Fax |
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Provider Business Mailing Address
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Address Line | 1662 47TH ST
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City | BROOKLYN
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State | NY
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Zip | 11204-1141
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Country | US
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Telephone | 347-746-0453
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LEAH LEBEL
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Credential |
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Telephone | 347-746-0453
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133N00000X
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Taxonomy Name | Nutritionist
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License Number |
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License Number State |
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