MEDICARE: THERESE FRANZESE M.S., R.D., C.D./N.

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	003887-1	NY
2	133V00000X	Registered Dietitian	003887-1	NY
3	133VN1004X	Pediatric Nutrition Registered Dietitian	003887-1	NY
4	133VN1005X	Renal Nutrition Registered Dietitian	003887-1	NY
5	133VN1006X	Metabolic Nutrition Registered Dietitian	003887-1	NY

General Provider Information

NPI Number	:	1518262583
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THERESE FRANZESE M.S., R.D., C.D./N.

Provider Business Mailing Address
First Line	:	951 W PARK AVE
Second Line	:
City	:	LONG BEACH
State	:	NY
Zip	:	11561-1408
Country	:	US
Telephone Number	:	516-807-8787
Fax Number	:	516-432-0802

Provider Business Practice Location Address
First Line	:	951 W PARK AVE
Second Line	:
City	:	LONG BEACH
State	:	NY
Zip	:	11561-1408
Country	:	US
Telephone Number	:	516-807-8787
Fax Number	:	516-432-0802

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

Provider Enumeration Date	:	01/21/2011
Last Update Date	:	01/21/2011

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