Provider Demographics
NPI:1407096506
Name:YOUR HEALTH YOUR CHOICE DIETETICS AND NUTRITION PLLC
Entity Type:Organization
Organization Name:YOUR HEALTH YOUR CHOICE DIETETICS AND NUTRITION PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RD
Authorized Official - Prefix:MRS
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:E
Authorized Official - Last Name:BOYEA-KERTESZ
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:315-345-6803
Mailing Address - Street 1:PO BOX 216
Mailing Address - Street 2:
Mailing Address - City:CAMILLUS
Mailing Address - State:NY
Mailing Address - Zip Code:13031-0216
Mailing Address - Country:US
Mailing Address - Phone:315-345-6803
Mailing Address - Fax:315-672-3009
Practice Address - Street 1:436 HINSDALE RD
Practice Address - Street 2:
Practice Address - City:CAMILLUS
Practice Address - State:NY
Practice Address - Zip Code:13031-1648
Practice Address - Country:US
Practice Address - Phone:315-345-6803
Practice Address - Fax:315-672-3009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-02
Last Update Date:2013-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005578133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYJ100000441Medicare PIN