| Brooklyn Longevity Nutrition, PLLC | |
|
2054 Bay Ridge Ave Bsmt Brooklyn NY 11204-4629 | |
| (646) 875-1655 | |
| Not Available |
| Full Name | Brooklyn Longevity Nutrition, PLLC |
|---|---|
| Speciality | Clinic/Center |
| Location | 2054 Bay Ridge Ave Bsmt, Brooklyn, New York |
| Authorized Official Name and Position | Zhen Deng (OWNER) |
| Authorized Official Contact | 6468751655 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Brooklyn Longevity Nutrition, PLLC 2054 Bay Ridge Ave Brooklyn NY 11204-4629 Ph: (646) 875-1655 | Brooklyn Longevity Nutrition, PLLC 2054 Bay Ridge Ave Bsmt Brooklyn NY 11204-4629 Ph: (646) 875-1655 |
| NPI Number | 1376188540 |
|---|---|
| Provider Enumeration Date | 11/12/2019 |
| Last Update Date | 08/24/2021 |
| Certification Date | 08/24/2021 |
| Medicare PECOS PAC ID | 7719382977 |
|---|---|
| Medicare Enrollment ID | O20210826000032 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1376188540 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | () | Primary |
| Provider Name | Zhen Deng |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1174181713 PECOS PAC ID: 8628473881 Enrollment ID: I20210826000100 |
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