Individual
MAVIS REN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD
Contact information
Practice address
9704 SUTPHIN BLVD, JAMAICA, NY 11435-4721
(718) 657-7088
(718) 657-7092
Mailing address
60 MADISON AVE, 5TH FLOOR, NEW YORK, NY 10010-1600
(212) 545-2400
(646) 312-0481
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
008461-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00695941
—
NY
Enumeration date
09/21/2015
Last updated
10/23/2015
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