Provider Demographics
NPI:1194941591
Name:GILLER, BONNIE RENEE (MS, RD, CDN, CDE)
Entity type:Individual
Prefix:MRS
First Name:BONNIE
Middle Name:RENEE
Last Name:GILLER
Suffix:
Gender:F
Credentials:MS, RD, CDN, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:383 PLYMOUTH ST
Mailing Address - Street 2:
Mailing Address - City:WEST HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11552-2450
Mailing Address - Country:US
Mailing Address - Phone:516-486-4569
Mailing Address - Fax:516-486-1792
Practice Address - Street 1:383 PLYMOUTH ST
Practice Address - Street 2:
Practice Address - City:WEST HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11552-2450
Practice Address - Country:US
Practice Address - Phone:516-486-4569
Practice Address - Fax:516-486-1792
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000251133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY8000066OtherGHI
NY1141750OtherUNITED HEALTHCARE
NY2142444OtherVYTRA HEALTH PLANS
NY8461009OtherCIGNA HEALTHCARE
NYP797526OtherOXFORD HEALTH PLANS
NY100114175001OtherUNITEDHEALTHCARE MEDICAID
NY205253POtherHIP