Provider Demographics
NPI:1306974324
Name:FREIMAN-LIFSHITZ, PHYLLIS (MS,RD-CDN)
Entity type:Individual
Prefix:
First Name:PHYLLIS
Middle Name:
Last Name:FREIMAN-LIFSHITZ
Suffix:
Gender:F
Credentials:MS,RD-CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1383 E 24TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11210-5142
Mailing Address - Country:US
Mailing Address - Phone:718-377-1082
Mailing Address - Fax:
Practice Address - Street 1:1383 E 24TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11210-5142
Practice Address - Country:US
Practice Address - Phone:718-377-1082
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY656766133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered