Provider Demographics
NPI:1982166385
Name:BREWSTER, CHARLES JR (CDN, RDN)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:
Last Name:BREWSTER
Suffix:JR
Gender:M
Credentials:CDN, RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 FIELDSTON TER APT 3F
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10471-3024
Mailing Address - Country:US
Mailing Address - Phone:917-359-6539
Mailing Address - Fax:
Practice Address - Street 1:255 FIELDSTON TER APT 3F
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10471-3024
Practice Address - Country:US
Practice Address - Phone:917-359-6539
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-03
Last Update Date:2019-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
86042647133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered