Provider Demographics
NPI:1164628673
Name:HARTOG, KATRINA E (MPH, CHES)
Entity Type:Individual
Prefix:
First Name:KATRINA
Middle Name:E
Last Name:HARTOG
Suffix:
Gender:F
Credentials:MPH, CHES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:357 DOUGLASS ST
Mailing Address - Street 2:APT 2
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11217-3106
Mailing Address - Country:US
Mailing Address - Phone:845-461-8588
Mailing Address - Fax:
Practice Address - Street 1:423 EAST 23 STREET
Practice Address - Street 2:VA HARBOR HEALTHCARE SYSTEM
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010
Practice Address - Country:US
Practice Address - Phone:212-686-7500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-22
Last Update Date:2009-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered