Provider Demographics
NPI:1073779765
Name:SIVAN, EINAV (MD RD CDN)
Entity Type:Individual
Prefix:
First Name:EINAV
Middle Name:
Last Name:SIVAN
Suffix:
Gender:F
Credentials:MD RD CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2869 GRAND CONCOURSE STE 1
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10468-1966
Mailing Address - Country:US
Mailing Address - Phone:718-676-0475
Mailing Address - Fax:718-676-0477
Practice Address - Street 1:8918 LEFFERTS BLVD
Practice Address - Street 2:
Practice Address - City:RICHMOND HILL
Practice Address - State:NY
Practice Address - Zip Code:11418-3218
Practice Address - Country:US
Practice Address - Phone:718-846-2222
Practice Address - Fax:718-846-2866
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-01
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0061541133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered