Provider Demographics
NPI:1376166918
Name:TRACEE YABLON BRENNER NUTRITION SERVICES
Entity Type:Organization
Organization Name:TRACEE YABLON BRENNER NUTRITION SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITAN NUTRITIONIST
Authorized Official - Prefix:
Authorized Official - First Name:TRACEE
Authorized Official - Middle Name:
Authorized Official - Last Name:YABLON BRENNER
Authorized Official - Suffix:
Authorized Official - Credentials:RDN
Authorized Official - Phone:201-741-0718
Mailing Address - Street 1:265 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:NYACK
Mailing Address - State:NY
Mailing Address - Zip Code:10960-5018
Mailing Address - Country:US
Mailing Address - Phone:201-741-0718
Mailing Address - Fax:
Practice Address - Street 1:265 RIVER RD
Practice Address - Street 2:
Practice Address - City:NYACK
Practice Address - State:NY
Practice Address - Zip Code:10960-5018
Practice Address - Country:US
Practice Address - Phone:201-741-0718
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-18
Last Update Date:2020-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty