Provider Demographics
NPI:1962171223
Name:REICH, REBECCA (RD)
Entity type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:
Last Name:REICH
Suffix:
Gender:F
Credentials:RD
Other - Prefix:MS
Other - First Name:RIVKY
Other - Middle Name:
Other - Last Name:REICH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RD
Mailing Address - Street 1:1225 44TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11219-2080
Mailing Address - Country:US
Mailing Address - Phone:347-746-0453
Mailing Address - Fax:347-412-3999
Practice Address - Street 1:1225 44TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11219-2080
Practice Address - Country:US
Practice Address - Phone:347-746-0453
Practice Address - Fax:347-412-3999
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-09
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY86173695133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered