Provider Demographics
NPI:1083705248
Name:KASKEL, PHYLLIS (RD)
Entity Type:Individual
Prefix:MS
First Name:PHYLLIS
Middle Name:
Last Name:KASKEL
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1251 RALEIGH ROAD
Mailing Address - Street 2:
Mailing Address - City:MAMARONECK
Mailing Address - State:NY
Mailing Address - Zip Code:10543
Mailing Address - Country:US
Mailing Address - Phone:212-241-6198
Mailing Address - Fax:212-849-2588
Practice Address - Street 1:1251 RALEIGH ROAD
Practice Address - Street 2:
Practice Address - City:MAMARONECK
Practice Address - State:NY
Practice Address - Zip Code:10543
Practice Address - Country:US
Practice Address - Phone:212-241-6198
Practice Address - Fax:212-849-2588
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002739-1133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY460735OtherREGISTERED DIETITIAN
NY002739-1OtherCERTIFIED DIETITIAN NUTRI