Provider Demographics
NPI:1649584632
Name:DECISION NUTRITION, PLLC
Entity Type:Organization
Organization Name:DECISION NUTRITION, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:KEREN
Authorized Official - Middle Name:
Authorized Official - Last Name:GILBERT
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RD
Authorized Official - Phone:516-939-9090
Mailing Address - Street 1:36 SYCAMORE LN
Mailing Address - Street 2:
Mailing Address - City:ROSLYN HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11577-2522
Mailing Address - Country:US
Mailing Address - Phone:917-207-5352
Mailing Address - Fax:
Practice Address - Street 1:55 NORTHERN BLVD
Practice Address - Street 2:SUITE 301
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-4027
Practice Address - Country:US
Practice Address - Phone:516-939-9090
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-02
Last Update Date:2010-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005095-1133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty