MEDICARE: CAROL BOZYMSKI MS, RDN, CDN, LDN

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	:	1376224881
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROL BOZYMSKI MS, RDN, CDN, LDN

Provider Business Mailing Address
First Line	:	10 LIBERTY ST APT 7A
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10005-1532
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	910 COVE POINT PL
Second Line	:
City	:	VERO BEACH
State	:	FL
Zip	:	32963-3996
Country	:	US
Telephone Number	:	201-477-0481
Fax Number	:

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

Provider Enumeration Date	:	07/27/2023
Last Update Date	:	07/27/2023

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