Nina Brodsky-Beno, RD

Individual provider Active NPI Registered Dietitian · East Rockaway, NY

NPI 1447360540 · NPPES record last updated Jul 8, 2007

Key facts

NPI
1447360540
Entity type
Individual (NPI type 1)
Primary specialty
Registered Dietitian 133V00000X
License
001549 (NY)
Practice address
31 Mallow Rd
East Rockaway, NY 11518
Phone
(516) 593-9610
NPI assigned
Aug 30, 2006
Sex
Female
Sole proprietor
No

Medicare participation

Medicare fee-for-service enrollment
Enrolled in NY

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
I20080910000034 NY Practitioner - Registered Dietitian Or Nutrition Professional 4688740905 Practice locations: East Rockaway, NY

National Provider Directory

Medicare enrollment (NPD)
Yes

State licenses

LicenseStateTypeSpecialty
671589NYMDRegistered Dietitian

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Dietitian 133V00000X 671589 NY
Registered Dietitian 133V00000X 001549 NY Yes

Addresses

Primary practice location

31 Mallow Rd
East Rockaway, NY 11518

Mailing address

14 Bulaire Rd
East Rockaway, NY 11518
Phone (516) 593-9610

Other providers in East Rockaway, NY

All providers in East Rockaway, NY · Registered Dietitian in New York

Sources for this page

Verify at the official NPI Registry.