Provider Demographics
NPI:1811608003
Name:STEFANIE G NUTRITION
Entity type:Organization
Organization Name:STEFANIE G NUTRITION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:STEFANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GIOVINE
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:631-504-9146
Mailing Address - Street 1:274 JEFFERSON ST APT 4B
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11237-2633
Mailing Address - Country:US
Mailing Address - Phone:631-504-9146
Mailing Address - Fax:
Practice Address - Street 1:274 JEFFERSON ST APT 4B
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11237-2633
Practice Address - Country:US
Practice Address - Phone:631-504-9146
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-08
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty