Provider Demographics
NPI:1588632996
Name:GADELOFF-MIZRAHI, BETTY (MS,RD,CDN)
Entity Type:Individual
Prefix:MRS
First Name:BETTY
Middle Name:
Last Name:GADELOFF-MIZRAHI
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 1:2442 OCEAN PKWY
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-6109
Mailing Address - Country:US
Mailing Address - Phone:718-382-9698
Mailing Address - Fax:718-382-9455
Practice Address - Street 1:2442 OCEAN PKWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-6109
Practice Address - Country:US
Practice Address - Phone:718-382-9698
Practice Address - Fax:718-382-9455
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006085133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered