MEDICARE: DYLAN GILBERT

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	133N00000X	Nutritionist

General Provider Information

NPI Number	:	1427833672
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DYLAN GILBERT

Provider Business Mailing Address
First Line	:	3801 HUDSON MANOR TER APT 4E
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10463-1115
Country	:	US
Telephone Number	:	917-921-4983
Fax Number	:

Provider Business Practice Location Address
First Line	:	3801 HUDSON MANOR TER APT 4E
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10463-1115
Country	:	US
Telephone Number	:	917-921-4983
Fax Number	:

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

Provider Enumeration Date	:	08/28/2023
Last Update Date	:	08/28/2023

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Directions to “ DYLAN GILBERT ” Practice Location

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