Provider Demographics
NPI:1154637171
Name:MALKIN-WASHEIM, DIANA LOUISE (MPH,RD, CDE, CD-N)
Entity Type:Individual
Prefix:MS
First Name:DIANA
Middle Name:LOUISE
Last Name:MALKIN-WASHEIM
Suffix:
Gender:F
Credentials:MPH,RD, CDE, CD-N
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1650 SELWYN AVE APT 10C
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10457-7627
Mailing Address - Country:US
Mailing Address - Phone:347-673-3991
Mailing Address - Fax:718-518-5740
Practice Address - Street 1:1650 SELWYN AVE APT 10C
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10457-7627
Practice Address - Country:US
Practice Address - Phone:347-673-3991
Practice Address - Fax:718-518-5740
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-27
Last Update Date:2010-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY833499133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered