Provider Demographics
NPI:1073729802
Name:MINTZER, DAWN SAKS (MS,RD,CDN)
Entity Type:Individual
Prefix:MS
First Name:DAWN
Middle Name:SAKS
Last Name:MINTZER
Suffix:
Gender:F
Credentials:MS,RD,CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:733 3RD AVE
Mailing Address - Street 2:16TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10017-2703
Mailing Address - Country:US
Mailing Address - Phone:646-790-5700
Mailing Address - Fax:646-478-9186
Practice Address - Street 1:733 3RD AVE
Practice Address - Street 2:16TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-2703
Practice Address - Country:US
Practice Address - Phone:646-790-5700
Practice Address - Fax:646-478-9186
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2019-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000990-1133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1H0902Medicare ID - Type Unspecified