Provider Demographics
NPI:1629898911
Name:GRUBLER, MALLORY (RD)
Entity type:Individual
Prefix:
First Name:MALLORY
Middle Name:
Last Name:GRUBLER
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:238 E 30TH ST APT 2W
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-8290
Mailing Address - Country:US
Mailing Address - Phone:347-656-2756
Mailing Address - Fax:
Practice Address - Street 1:238 E 30TH ST APT 2W
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-8290
Practice Address - Country:US
Practice Address - Phone:347-656-2756
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-12
Last Update Date:2024-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered