Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | X004528-1 | NY |
NPI | 1528135290 |
---|---|
Provider Name | Dr. Nelleke Greendyk |
First Address | West Milford, NJ 07480-2708 |
Second Address | Warwick, NY 10990-4107 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/11/2006 |
Last Update Date | 07/04/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1528135290 | NPI (01) | |
X27211 | (02) | NY |