MEDICARE: PARVANEH GOLBARI INC

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	006441-1
2	133NN1002X	Nutrition Education Nutritionist	943609	NY

General Provider Information

NPI Number	:	1437652369
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PARVANEH GOLBARI INC

Provider Business Mailing Address
First Line	:	47 STEPPING STONE LN
Second Line	:
City	:	GREAT NECK
State	:	NY
Zip	:	11024-1313
Country	:	US
Telephone Number	:	516-330-3970
Fax Number	:	516-482-3473

Provider Business Practice Location Address
First Line	:	6902 AUSTIN ST FL 2
Second Line	:
City	:	FOREST HILLS
State	:	NY
Zip	:	11375-4250
Country	:	US
Telephone Number	:	516-330-3970
Fax Number	:	516-482-3473

Authorized Official
Title or Position	:	REGISTERED DIETITIAN/NUTRITIONIST
Name	:	PARVANEH GOLBARI
Credential	:	RD, CDN
Telephone Number	:	516-330-3970

Provider Enumeration Date	:	03/16/2018
Last Update Date	:	05/23/2022

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