Provider Demographics
NPI:1952578882
Name:GEORGE-ALEXANDER, GLENIS ANN (RD, CDR)
Entity Type:Individual
Prefix:
First Name:GLENIS
Middle Name:ANN
Last Name:GEORGE-ALEXANDER
Suffix:
Gender:F
Credentials:RD, CDR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 27842
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10087-7842
Mailing Address - Country:US
Mailing Address - Phone:718-670-1651
Mailing Address - Fax:516-437-4167
Practice Address - Street 1:525 E 68TH ST
Practice Address - Street 2:GREENBERG PAVILION RM 10-171
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-4870
Practice Address - Country:US
Practice Address - Phone:121-746-0838
Practice Address - Fax:516-437-4167
Is Sole Proprietor?:No
Enumeration Date:2008-05-09
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005779-1133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered