Provider Demographics
NPI:1366988503
Name:BERESNITZKY, ANA (RD,CDN)
Entity type:Individual
Prefix:
First Name:ANA
Middle Name:
Last Name:BERESNITZKY
Suffix:
Gender:F
Credentials:RD,CDN
Other - Prefix:MS
Other - First Name:ANA
Other - Middle Name:
Other - Last Name:BERESNITZKY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RD,CDN
Mailing Address - Street 1:51 PARKER BLVD
Mailing Address - Street 2:
Mailing Address - City:MONSEY
Mailing Address - State:NY
Mailing Address - Zip Code:10952-1449
Mailing Address - Country:US
Mailing Address - Phone:845-659-4947
Mailing Address - Fax:
Practice Address - Street 1:51 PARKER BLVD
Practice Address - Street 2:
Practice Address - City:MONSEY
Practice Address - State:NY
Practice Address - Zip Code:10952-1449
Practice Address - Country:US
Practice Address - Phone:845-659-4947
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-11
Last Update Date:2017-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008826-1133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered