Provider Demographics
NPI:1053663955
Name:LASTOVKA, NATALLIA (RD, CDCES, LDN)
Entity Type:Individual
Prefix:
First Name:NATALLIA
Middle Name:
Last Name:LASTOVKA
Suffix:
Gender:F
Credentials:RD, CDCES, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:172 MIDDLETOWN BLVD STE 203
Mailing Address - Street 2:
Mailing Address - City:LANGHORNE
Mailing Address - State:PA
Mailing Address - Zip Code:19047-1871
Mailing Address - Country:US
Mailing Address - Phone:215-716-1650
Mailing Address - Fax:215-600-3354
Practice Address - Street 1:172 MIDDLETOWN BLVD STE 203
Practice Address - Street 2:
Practice Address - City:LANGHORNE
Practice Address - State:PA
Practice Address - Zip Code:19047-1871
Practice Address - Country:US
Practice Address - Phone:215-716-1650
Practice Address - Fax:215-600-3354
Is Sole Proprietor?:No
Enumeration Date:2012-10-03
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1069849133N00000X, 133NN1002X, 133V00000X, 133VN1004X, 133VN1005X, 133VN1006X
PADN004974133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
No133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric
No133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal
No133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic