MEDICARE: NATALIA WILUK RD

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	86014953	NY

General Provider Information

NPI Number	:	1093168205
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NATALIA WILUK RD

Provider Business Mailing Address
First Line	:	29 FOREST AVE
Second Line	:
City	:	VALLEY STREAM
State	:	NY
Zip	:	11581-1307
Country	:	US
Telephone Number	:	631-747-1165
Fax Number	:

Provider Business Practice Location Address
First Line	:	29 FOREST AVE
Second Line	:
City	:	VALLEY STREAM
State	:	NY
Zip	:	11581-1307
Country	:	US
Telephone Number	:	631-747-1165
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/22/2016
Last Update Date	:	07/22/2016

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Directions to “ NATALIA WILUK RD” Practice Location

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