Provider Demographics
NPI:1841005881
Name:PRIETO, MANUEL TAYAG (RD)
Entity type:Individual
Prefix:MR
First Name:MANUEL
Middle Name:TAYAG
Last Name:PRIETO
Suffix:
Gender:M
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:723 CARMAN AVE APT 6
Mailing Address - Street 2:
Mailing Address - City:WESTBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11590-6449
Mailing Address - Country:US
Mailing Address - Phone:516-578-1352
Mailing Address - Fax:
Practice Address - Street 1:723 CARMAN AVE APT 6
Practice Address - Street 2:
Practice Address - City:WESTBURY
Practice Address - State:NY
Practice Address - Zip Code:11590-6449
Practice Address - Country:US
Practice Address - Phone:516-578-1352
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-07
Last Update Date:2025-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered