MEDICARE: VVF DIETITIAN-NUTRITIONIST PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian

General Provider Information

NPI Number	:	1083151872
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VVF DIETITIAN-NUTRITIONIST PC

Provider Business Mailing Address
First Line	:	444 NEPTUNE AVE
Second Line	:	STE 8J
City	:	BROOKLYN
State	:	NY
Zip	:	11224-4456
Country	:	US
Telephone Number	:	718-975-8500
Fax Number	:	718-975-8502

Provider Business Practice Location Address
First Line	:	1009 BRIGHTON BEACH AVE
Second Line	:	2ND FL
City	:	BROOKLYN
State	:	NY
Zip	:	11235-5659
Country	:	US
Telephone Number	:	718-975-8500
Fax Number	:	718-975-8502

Authorized Official
Title or Position	:	OWNER
Name	:	VICTORYA FOGEL
Credential	:	RD
Telephone Number	:	718-975-8500

Provider Enumeration Date	:	01/31/2017
Last Update Date	:	01/31/2017

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