Basic Information
Provider Information | |||||||||
NPI: | 1255581963 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | ZIPPER | ||||||||
FirstName: | BETH | ||||||||
MiddleName: | S | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | R.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | BERMAN | ||||||||
OtherFirstName: | BETH | ||||||||
OtherMiddleName: | SUSAN | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | R.D. | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 951 BROKEN SOUND PKWY NW | ||||||||
Address2: | SUITE 225 | ||||||||
City: | BOCA RATON | ||||||||
State: | FL | ||||||||
PostalCode: | 334873507 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5612419300 | ||||||||
FaxNumber: | 5613720214 | ||||||||
Practice Location | |||||||||
Address1: | 5365 W ATLANTIC AVE | ||||||||
Address2: | SUITE 504 | ||||||||
City: | DELRAY BEACH | ||||||||
State: | FL | ||||||||
PostalCode: | 334848172 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5614956300 | ||||||||
FaxNumber: | 5614958877 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 09/30/2008 | ||||||||
LastUpdateDate: | 09/30/2008 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | ND5339 | FL | Y |   | Dietary & Nutritional Service Providers | Dietitian, Registered |   |
ID Information
ID | Type | State | Issuer | Description | ND5339 | 01 | FL | FLORIDA LICENSE | OTHER |