Provider Demographics
NPI:1427688266
Name:NEW YORK DIETETIC AND REGISTERED PROFESSIONAL NURSE PLLC
Entity type:Organization
Organization Name:NEW YORK DIETETIC AND REGISTERED PROFESSIONAL NURSE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:HYMSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-674-4114
Mailing Address - Street 1:804 W 180TH ST APT 24
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10033-3509
Mailing Address - Country:US
Mailing Address - Phone:201-674-4114
Mailing Address - Fax:
Practice Address - Street 1:804 W 180TH ST APT 24
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10033-3509
Practice Address - Country:US
Practice Address - Phone:201-674-4114
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-21
Last Update Date:2020-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WN1003XNursing Service ProvidersRegistered NurseNutrition SupportGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Multi-Specialty