Provider Demographics
NPI:1164863965
Name:SMULAKOWSKI, LEON (RD)
Entity Type:Individual
Prefix:MR
First Name:LEON
Middle Name:
Last Name:SMULAKOWSKI
Suffix:
Gender:M
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3210 RIVERDALE AVE
Mailing Address - Street 2:8F
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-3695
Mailing Address - Country:US
Mailing Address - Phone:347-924-8389
Mailing Address - Fax:
Practice Address - Street 1:3210 RIVERDALE AVE
Practice Address - Street 2:8F
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-3695
Practice Address - Country:US
Practice Address - Phone:347-924-8389
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-10
Last Update Date:2013-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1105190133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered