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General NPI Number Information
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NPI Number | 1982103719
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Entity Type | Organization
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Legal Business Name | BETH WARREN NUTRITION LLC
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Dates
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Enumeration Date | 02/07/2018
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Last Update Date | 02/07/2018
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Provider Practice Location Address
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Address Line | 1551 E 4TH ST
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City | BROOKLYN
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State | NY
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Zip | 11230-6318
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Country | US
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Telephone | 347-292-1725
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Fax | 212-202-6025
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Provider Business Mailing Address
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Address Line | 1551 E 4TH ST
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City | BROOKLYN
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State | NY
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Zip | 11230-6318
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Country | US
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Telephone | 347-292-1725
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Fax | 212-202-6025
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Authorized Official
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Title or Position | OWNER
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Name | BETH A WARREN
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Credential | RD
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Telephone | 347-292-1725
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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 | 007422
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License Number State | NY
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