Provider Demographics
NPI:1073258026
Name:ETHNIK NUTRITION PRACTICE LLC
Entity Type:Organization
Organization Name:ETHNIK NUTRITION PRACTICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPHINE
Authorized Official - Middle Name:BINTU
Authorized Official - Last Name:KATOBO
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:646-245-1945
Mailing Address - Street 1:105 W 125TH ST FRNT 1
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10027-4444
Mailing Address - Country:US
Mailing Address - Phone:646-245-1945
Mailing Address - Fax:
Practice Address - Street 1:105 W 125TH ST FRNT 1
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10027-4444
Practice Address - Country:US
Practice Address - Phone:646-245-1945
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-04
Last Update Date:2023-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty