Provider Demographics
NPI:1053640920
Name:EBERSTARK, CHAYA SARA (RD CDN)
Entity Type:Individual
Prefix:MRS
First Name:CHAYA
Middle Name:SARA
Last Name:EBERSTARK
Suffix:
Gender:F
Credentials:RD CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 LINWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:CEDARHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11516-1720
Mailing Address - Country:US
Mailing Address - Phone:917-612-3373
Mailing Address - Fax:
Practice Address - Street 1:304 LINWOOD AVE
Practice Address - Street 2:
Practice Address - City:CEDARHURST
Practice Address - State:NY
Practice Address - Zip Code:11516-1720
Practice Address - Country:US
Practice Address - Phone:917-612-3373
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-23
Last Update Date:2010-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1022512133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered