Provider Demographics
NPI:1508009333
Name:KHADER, DINA (MS RD, CDN)
Entity Type:Individual
Prefix:
First Name:DINA
Middle Name:
Last Name:KHADER
Suffix:
Gender:F
Credentials:MS RD, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 SMITH AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT KISCO
Mailing Address - State:NY
Mailing Address - Zip Code:10549-2838
Mailing Address - Country:US
Mailing Address - Phone:914-242-0124
Mailing Address - Fax:
Practice Address - Street 1:39 SMITH AVE
Practice Address - Street 2:
Practice Address - City:MOUNT KISCO
Practice Address - State:NY
Practice Address - Zip Code:10549-2838
Practice Address - Country:US
Practice Address - Phone:914-242-0124
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-09
Last Update Date:2009-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY00376133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered