Ren, Mavis

Ren, Mavis is an individual health care provider with primary practice located at 9704 Sutphin Blvd , Jamaica NY 11435-4721. She recently has only one registered license in Dietary & Nutritional Service Providers / Dietitian, Registered, which is considered as her primary health care specialty. Ren, Mavis can be contacted via phone (718) 657-7088.

Contact Information

Primary practice address
9704 Sutphin Blvd Jamaica NY 11435-4721
Phone: (718) 657-7088
Fax: (718) 657-7092
Website:
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Health care specialties

SpecialtyCodeLicense #State
Dietary & Nutritional Service Providers / Dietitian, Registered 133V00000X 008461-1 New York

Profile Details

NPI number 1295104172
LBN Legal business name Ren, Mavis
Credentials Registered Dietitian (RD)
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 21st, 2015
Last updated Oct 23rd, 2015 - about 9 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1295104172 NPPES
New York MEDICAID 00695941

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