Provider Demographics
NPI:1417411471
Name:NESIC, NATASHA KATARINA (NASM CES)
Entity Type:Individual
Prefix:MS
First Name:NATASHA
Middle Name:KATARINA
Last Name:NESIC
Suffix:
Gender:F
Credentials:NASM CES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:237 W 74TH ST # 6-11
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-2108
Mailing Address - Country:US
Mailing Address - Phone:914-471-1234
Mailing Address - Fax:
Practice Address - Street 1:237 W 74TH ST # 6-11
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-2108
Practice Address - Country:US
Practice Address - Phone:914-471-1234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-24
Last Update Date:2019-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Single Specialty
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation PractitionerGroup - Single Specialty