Provider Demographics
NPI:1508045659
Name:ARACENA, SONIA IBELKA (RD)
Entity Type:Individual
Prefix:
First Name:SONIA
Middle Name:IBELKA
Last Name:ARACENA
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3030 JOHNSON AVE
Mailing Address - Street 2:APT. 2F
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-3540
Mailing Address - Country:US
Mailing Address - Phone:718-884-4469
Mailing Address - Fax:
Practice Address - Street 1:622 W 168TH ST
Practice Address - Street 2:HP 6
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-3720
Practice Address - Country:US
Practice Address - Phone:212-305-6974
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-25
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006181133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered