Provider Demographics
NPI:1598484214
Name:BISTRICER, MELISSA (MS, RDN)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:BISTRICER
Suffix:
Gender:F
Credentials:MS, RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:698 PARK LN
Mailing Address - Street 2:
Mailing Address - City:CEDARHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11516-1040
Mailing Address - Country:US
Mailing Address - Phone:516-724-3547
Mailing Address - Fax:
Practice Address - Street 1:10538 ROCKAWAY BEACH BLVD
Practice Address - Street 2:
Practice Address - City:ROCKAWAY PARK
Practice Address - State:NY
Practice Address - Zip Code:11694-2645
Practice Address - Country:US
Practice Address - Phone:718-869-7500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-25
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered