Basic Information
| Provider Information | |||||||||
| NPI: | 1083151872 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | VVF DIETITIAN-NUTRITIONIST PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 444 NEPTUNE AVE | ||||||||
| Address2: | STE 8J | ||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112244456 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7189758500 | ||||||||
| FaxNumber: | 7189758502 | ||||||||
| Practice Location | |||||||||
| Address1: | 1009 BRIGHTON BEACH AVE | ||||||||
| Address2: | 2ND FL | ||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112355659 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7189758500 | ||||||||
| FaxNumber: | 7189758502 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/31/2017 | ||||||||
| LastUpdateDate: | 01/31/2017 | ||||||||
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| AuthorizedOfficialLastName: | FOGEL | ||||||||
| AuthorizedOfficialFirstName: | VICTORYA | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7189758500 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | RD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.