Provider Demographics
NPI:1720259823
Name:OWENS, TERRYL (MPH, RD)
Entity Type:Individual
Prefix:
First Name:TERRYL
Middle Name:
Last Name:OWENS
Suffix:
Gender:F
Credentials:MPH, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 CROSS LN
Mailing Address - Street 2:
Mailing Address - City:GLEN HEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11545-1109
Mailing Address - Country:US
Mailing Address - Phone:646-462-5714
Mailing Address - Fax:
Practice Address - Street 1:5 CROSS LN
Practice Address - Street 2:
Practice Address - City:GLEN HEAD
Practice Address - State:NY
Practice Address - Zip Code:11545-1109
Practice Address - Country:US
Practice Address - Phone:646-462-5714
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-17
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY85002123133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered