Provider Demographics
NPI:1255729034
Name:BORNSTEIN, MERYL (RDN, CDN)
Entity type:Individual
Prefix:MS
First Name:MERYL
Middle Name:
Last Name:BORNSTEIN
Suffix:
Gender:F
Credentials:RDN, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 CONCORD AVE
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11572-5415
Mailing Address - Country:US
Mailing Address - Phone:516-766-6164
Mailing Address - Fax:516-766-6164
Practice Address - Street 1:107 CONCORD AVE
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:NY
Practice Address - Zip Code:11572-5415
Practice Address - Country:US
Practice Address - Phone:516-766-6164
Practice Address - Fax:516-766-6164
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-02
Last Update Date:2015-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001838-1133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered