Provider Demographics
NPI:1093005027
Name:WARREN, BETH ALLISON (MS, RD)
Entity Type:Individual
Prefix:MRS
First Name:BETH
Middle Name:ALLISON
Last Name:WARREN
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1551 E 4TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-6318
Mailing Address - Country:US
Mailing Address - Phone:718-336-3343
Mailing Address - Fax:212-202-6025
Practice Address - Street 1:1551 E 4TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-6318
Practice Address - Country:US
Practice Address - Phone:718-336-3343
Practice Address - Fax:212-202-6025
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-11
Last Update Date:2018-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1042977133V00000X
NY007422133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered