Provider Demographics
NPI:1982148052
Name:BALANCE DIETETICS-NUTRITION & PSYCHOLOGICAL EATING DISORDER PLLC
Entity Type:Organization
Organization Name:BALANCE DIETETICS-NUTRITION & PSYCHOLOGICAL EATING DISORDER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER AND EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MELAINIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RDN, CEDRD
Authorized Official - Phone:212-645-6903
Mailing Address - Street 1:112 W 27TH ST FL 7
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-6240
Mailing Address - Country:US
Mailing Address - Phone:212-645-6903
Mailing Address - Fax:
Practice Address - Street 1:112 W 27TH ST FL 7
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-6240
Practice Address - Country:US
Practice Address - Phone:212-645-6903
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-08
Last Update Date:2016-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty