Provider Demographics
NPI:1982111035
Name:BLUMENFELD, ILANIT (RD, CDN, MPH)
Entity Type:Individual
Prefix:MRS
First Name:ILANIT
Middle Name:
Last Name:BLUMENFELD
Suffix:
Gender:F
Credentials:RD, CDN, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 BLACK WALNUT RD
Mailing Address - Street 2:
Mailing Address - City:SCARSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10583-4572
Mailing Address - Country:US
Mailing Address - Phone:646-326-4658
Mailing Address - Fax:
Practice Address - Street 1:7-11 S BROADWAY STE 100
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10601-3520
Practice Address - Country:US
Practice Address - Phone:914-723-4900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-10
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009006-1133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty