Provider Demographics
NPI:1174938468
Name:BRAY, TAMMY (MSRD CDN)
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:
Last Name:BRAY
Suffix:
Gender:F
Credentials:MSRD CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 LOZIER AVE
Mailing Address - Street 2:
Mailing Address - City:EMERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07630-1140
Mailing Address - Country:US
Mailing Address - Phone:212-987-7599
Mailing Address - Fax:
Practice Address - Street 1:85 LOZIER AVE
Practice Address - Street 2:
Practice Address - City:EMERSON
Practice Address - State:NJ
Practice Address - Zip Code:07630-1140
Practice Address - Country:US
Practice Address - Phone:212-987-7599
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-25
Last Update Date:2014-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY48 008049133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered