| Doctor Name: | MAVIS REN |
| NPI Number: | 1295104172 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | RD |
| License Number: | 008461-1 |
| Business Practice Address: | 9704 Sutphin Blvd Jamaica, NY - 114354721 |
| Business Phone Number: | 7186577088 |
| Business Fax Number: | 7186577092 |
| Mailing Address: | 60 Madison Ave, 5th Floor NEW YORK |
| State: | NY |
| Postal Code: | 100101600 |
| Phone Number: | 2125452400 |
| Fax Number: | 6463120481 |
| NPI Enumeration Date: | 09/21/2015 |
| NPI Last Update Date: | 10/23/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 133V00000X |
| License Number: | 008461-1 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Dietary & Nutritional Service Providers |
| Taxonomy Classification: | Dietitian, Registered |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A registered dietician (RD) is a food and nutrition expert who has successfully completed a minimum of a bachelor |