Provider Demographics
NPI:1346938974
Name:THOMOPOULOS TITOMIHELAKIS, KRISTINA D (MS, RDN, CDN, CPT)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:D
Last Name:THOMOPOULOS TITOMIHELAKIS
Suffix:
Gender:F
Credentials:MS, RDN, CDN, CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 E 96TH ST # 31D
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-3835
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:44 GREEN ST STE 2
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-3393
Practice Address - Country:US
Practice Address - Phone:516-206-2058
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-01
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY86131520133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered