Provider Demographics
NPI:1376056218
Name:NUTRITIONAL COUNSELING DIETETICS ASSOCIATES PLLC
Entity Type:Organization
Organization Name:NUTRITIONAL COUNSELING DIETETICS ASSOCIATES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:ASAL
Authorized Official - Middle Name:
Authorized Official - Last Name:HAKIM
Authorized Official - Suffix:
Authorized Official - Credentials:RD, CDN
Authorized Official - Phone:516-695-1887
Mailing Address - Street 1:22 S MARYLAND AVE
Mailing Address - Street 2:
Mailing Address - City:PORT WASHINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11050-2913
Mailing Address - Country:US
Mailing Address - Phone:516-695-1887
Mailing Address - Fax:
Practice Address - Street 1:22 S MARYLAND AVE
Practice Address - Street 2:
Practice Address - City:PORT WASHINGTON
Practice Address - State:NY
Practice Address - Zip Code:11050-2913
Practice Address - Country:US
Practice Address - Phone:516-695-1887
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-14
Last Update Date:2018-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009082133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty