Provider Demographics
NPI:1255680195
Name:BONTEMPO, AMANDA (MS RD CDN)
Entity Type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:
Last Name:BONTEMPO
Suffix:
Gender:F
Credentials:MS RD CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1625 POPLAR ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-2648
Mailing Address - Country:US
Mailing Address - Phone:718-862-8840
Mailing Address - Fax:718-405-8551
Practice Address - Street 1:1625 POPLAR ST
Practice Address - Street 2:SUITE 101
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-2648
Practice Address - Country:US
Practice Address - Phone:718-862-8840
Practice Address - Fax:718-405-8551
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-06
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006903133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1063525152OtherMONTEFIORE MEDICAL CENTER GROUP ORGANIZATION PROVIDER NPI