Provider Demographics
NPI:1730636572
Name:BERENSTEIN, VANESSA (MA, RDN)
Entity Type:Individual
Prefix:MS
First Name:VANESSA
Middle Name:
Last Name:BERENSTEIN
Suffix:
Gender:F
Credentials:MA, RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 CENTRAL PARK W APT 16G
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-7715
Mailing Address - Country:US
Mailing Address - Phone:646-535-2742
Mailing Address - Fax:
Practice Address - Street 1:6829 ELM ST STE 300
Practice Address - Street 2:
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22101-3845
Practice Address - Country:US
Practice Address - Phone:703-532-4892
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-09
Last Update Date:2016-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY86035651133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered