Provider Demographics
NPI:1326819350
Name:CHAYBAN ABDUL MASSIH, ANA KAREN (MS RD CDN CDCES CCTD)
Entity Type:Individual
Prefix:
First Name:ANA
Middle Name:KAREN
Last Name:CHAYBAN ABDUL MASSIH
Suffix:
Gender:F
Credentials:MS RD CDN CDCES CCTD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 ADAMS PL
Mailing Address - Street 2:
Mailing Address - City:WEST ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11795-1443
Mailing Address - Country:US
Mailing Address - Phone:516-857-3766
Mailing Address - Fax:
Practice Address - Street 1:1111 MARCUS AVE STE M10C
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11042-2036
Practice Address - Country:US
Practice Address - Phone:516-266-3592
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-09
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009848-01133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered