Active NPI
Leslie Michele Giambalvo, RD
- Registered Dietitian
- Berwyn, IL
National Provider Identifier
1376011213
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 164.003848
- Practice address
- 3249 Oak Park Ave
Berwyn, IL 60402-3429 - Phone
- (708) 783-3077
- Fax
- (708) 783-0654
- NPI assigned
- Nov 8, 2018
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 164.003848 | IL | Primary |
Addresses
Primary practice location
3249 Oak Park Ave
Berwyn, IL 60402-3429
Mailing address
5025 N Oketo Ave
Harwood Heights, IL 60706-3530
Phone (773) 206-5094
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 164.003848 | IL | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1541635200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1542240000000",
"number": "1376011213",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5025 N OKETO AVE",
"city": "HARWOOD HEIGHTS",
"state": "IL",
"postal_code": "607063530",
"telephone_number": "773-206-5094"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3249 OAK PARK AVE",
"city": "BERWYN",
"state": "IL",
"postal_code": "604023429",
"telephone_number": "708-783-3077",
"fax_number": "708-783-0654"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GIAMBALVO",
"first_name": "LESLIE",
"middle_name": "MICHELE",
"name_prefix": "Ms.",
"credential": "RD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-11-08",
"last_updated": "2018-11-15",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "IL",
"license": "164.003848",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Berwyn, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.