Provider Demographics
NPI:1275022725
Name:WINOGRAD, MALKA LEAH (RD CDN)
Entity Type:Individual
Prefix:
First Name:MALKA
Middle Name:LEAH
Last Name:WINOGRAD
Suffix:
Gender:F
Credentials:RD CDN
Other - Prefix:
Other - First Name:MALKA
Other - Middle Name:L
Other - Last Name:MOAS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1216 E 32ND ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11210-4743
Mailing Address - Country:US
Mailing Address - Phone:347-603-2331
Mailing Address - Fax:
Practice Address - Street 1:1216 E 32ND ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11210-4743
Practice Address - Country:US
Practice Address - Phone:347-603-2331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-09
Last Update Date:2018-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1016745133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty