Provider Demographics
NPI:1275762510
Name:KARTASHEVSKY, JENNIFER (RD,CDE,CON)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:KARTASHEVSKY
Suffix:
Gender:F
Credentials:RD,CDE,CON
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 WATER STREET
Mailing Address - Street 2:20TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10038
Mailing Address - Country:US
Mailing Address - Phone:212-256-3682
Mailing Address - Fax:
Practice Address - Street 1:349 HENRY STREET
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201
Practice Address - Country:US
Practice Address - Phone:718-780-2971
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-08
Last Update Date:2009-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006719133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY006719OtherLICENSE