Provider Demographics
NPI:1164728804
Name:KOROLEV, DANIEL
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:KOROLEV
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 NEWARK ST APT 4I
Mailing Address - Street 2:
Mailing Address - City:HOBOKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07030-2447
Mailing Address - Country:US
Mailing Address - Phone:212-444-8053
Mailing Address - Fax:646-807-4812
Practice Address - Street 1:49 W 24TH ST
Practice Address - Street 2:SUITE 601
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-3206
Practice Address - Country:US
Practice Address - Phone:212-444-8053
Practice Address - Fax:646-807-4812
Is Sole Proprietor?:No
Enumeration Date:2011-01-27
Last Update Date:2011-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
No133N00000XDietary & Nutritional Service ProvidersNutritionist