Provider Demographics
NPI:1386818573
Name:BROOK, RANDI SUE (MS, RD, CDE, CDN)
Entity Type:Individual
Prefix:
First Name:RANDI
Middle Name:SUE
Last Name:BROOK
Suffix:
Gender:F
Credentials:MS, RD, CDE, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:317 E 17TH ST
Mailing Address - Street 2:8 TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-3804
Mailing Address - Country:US
Mailing Address - Phone:212-420-3425
Mailing Address - Fax:212-420-2224
Practice Address - Street 1:317 E 17TH ST
Practice Address - Street 2:8 TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-3804
Practice Address - Country:US
Practice Address - Phone:212-420-3425
Practice Address - Fax:212-420-2224
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-17
Last Update Date:2009-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006128-1133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered