Provider Demographics
NPI:1144038936
Name:WENGROFSKY, ALYSSA (RD)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:WENGROFSKY
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:646 BARNARD AVE
Mailing Address - Street 2:
Mailing Address - City:WOODMERE
Mailing Address - State:NY
Mailing Address - Zip Code:11598-2729
Mailing Address - Country:US
Mailing Address - Phone:516-477-7593
Mailing Address - Fax:
Practice Address - Street 1:646 BARNARD AVE
Practice Address - Street 2:
Practice Address - City:WOODMERE
Practice Address - State:NY
Practice Address - Zip Code:11598-2729
Practice Address - Country:US
Practice Address - Phone:516-477-7593
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-25
Last Update Date:2024-12-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered