Provider Demographics
NPI:1346725686
Name:BUKOLT, KAREN (RDN, CDN)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:BUKOLT
Suffix:
Gender:F
Credentials:RDN, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 W 26TH ST APT 5P
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-6747
Mailing Address - Country:US
Mailing Address - Phone:213-447-8292
Mailing Address - Fax:
Practice Address - Street 1:200 W 26TH ST APT 5P
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-6747
Practice Address - Country:US
Practice Address - Phone:213-447-8292
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-02
Last Update Date:2018-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
86086875133V00000X
NY0099486-1133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered