Provider Demographics
NPI:1518523976
Name:ZELTMANN, CAMILLE GERVACIO
Entity Type:Individual
Prefix:
First Name:CAMILLE
Middle Name:GERVACIO
Last Name:ZELTMANN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5327 72ND PL
Mailing Address - Street 2:
Mailing Address - City:MASPETH
Mailing Address - State:NY
Mailing Address - Zip Code:11378-1526
Mailing Address - Country:US
Mailing Address - Phone:917-502-2272
Mailing Address - Fax:
Practice Address - Street 1:5327 72ND PL
Practice Address - Street 2:
Practice Address - City:MASPETH
Practice Address - State:NY
Practice Address - Zip Code:11378-1526
Practice Address - Country:US
Practice Address - Phone:917-502-2272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-11
Last Update Date:2019-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY86050777133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered