Provider Demographics
NPI:1699598193
Name:HEALTHY BITES NY RD, LLC
Entity type:Organization
Organization Name:HEALTHY BITES NY RD, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAIME
Authorized Official - Middle Name:
Authorized Official - Last Name:KWOK
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RD, CDN, CDCES
Authorized Official - Phone:877-455-3696
Mailing Address - Street 1:642 LAMOKA AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10312-3438
Mailing Address - Country:US
Mailing Address - Phone:877-455-3696
Mailing Address - Fax:917-677-6619
Practice Address - Street 1:642 LAMOKA AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10312-3438
Practice Address - Country:US
Practice Address - Phone:877-455-3696
Practice Address - Fax:917-677-6619
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-04
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty