Provider Demographics
NPI:1932120821
Name:BINGHAM, MARY ELLEN (MS, RD, CDN)
Entity Type:Individual
Prefix:MISS
First Name:MARY ELLEN
Middle Name:
Last Name:BINGHAM
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 1:279 E 44TH ST
Mailing Address - Street 2:APT 2C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10017-4336
Mailing Address - Country:US
Mailing Address - Phone:617-784-3678
Mailing Address - Fax:
Practice Address - Street 1:51 E 42ND ST
Practice Address - Street 2:SUITE 1400
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-5404
Practice Address - Country:US
Practice Address - Phone:617-784-3678
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-23
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY00952137133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered