Provider Demographics
NPI:1114308459
Name:M. RENDA, RD, CDN
Entity Type:Organization
Organization Name:M. RENDA, RD, CDN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN, CDN
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARION
Authorized Official - Middle Name:
Authorized Official - Last Name:RENDA
Authorized Official - Suffix:
Authorized Official - Credentials:RD, CDN
Authorized Official - Phone:516-672-5927
Mailing Address - Street 1:7 PARK LN
Mailing Address - Street 2:
Mailing Address - City:LEVITTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11756-1115
Mailing Address - Country:US
Mailing Address - Phone:516-672-5927
Mailing Address - Fax:
Practice Address - Street 1:2415 JERUSALEM AVE
Practice Address - Street 2:SUITE 106
Practice Address - City:NORTH BELLMORE
Practice Address - State:NY
Practice Address - Zip Code:11710-1870
Practice Address - Country:US
Practice Address - Phone:516-672-5927
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-12
Last Update Date:2015-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005185-1261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service