Provider Demographics
NPI:1053486407
Name:BRG DIETETICS & NUTRITION, P.C.
Entity Type:Organization
Organization Name:BRG DIETETICS & NUTRITION, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT REGISTERED DIETITIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:BONNIE
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:GILLER
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RD, CDN, CDE
Authorized Official - Phone:516-486-4569
Mailing Address - Street 1:383 PLYMOUTH ST
Mailing Address - Street 2:
Mailing Address - City:WEST HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11552-2450
Mailing Address - Country:US
Mailing Address - Phone:516-486-4569
Mailing Address - Fax:516-486-1792
Practice Address - Street 1:383 PLYMOUTH ST
Practice Address - Street 2:
Practice Address - City:WEST HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11552-2450
Practice Address - Country:US
Practice Address - Phone:516-486-4569
Practice Address - Fax:516-486-1792
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000251133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1141750OtherUNITED HEALTHCARE
NY205253POtherHIP
NY2142444OtherVYTRA HEALTH PLANS
NY8000066OtherGHI
NYP797526OtherOXFORD HEALTH PLANS
NY8461009OtherCIGNA HEALTHCARE