Provider Demographics
NPI:1568823813
Name:NUTRITION CARE P.C.
Entity Type:Organization
Organization Name:NUTRITION CARE P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:RAFAILOVA
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:917-498-4211
Mailing Address - Street 1:2900 E 29TH ST APT 2F
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-2272
Mailing Address - Country:US
Mailing Address - Phone:917-498-4211
Mailing Address - Fax:
Practice Address - Street 1:2900 EAST 29TH STREET APT.2F
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235
Practice Address - Country:US
Practice Address - Phone:917-498-4211
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-15
Last Update Date:2016-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008397133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty