Provider Demographics
NPI:1518921113
Name:BATHEJA, RITA K (MS RD CDN)
Entity Type:Individual
Prefix:MRS
First Name:RITA
Middle Name:K
Last Name:BATHEJA
Suffix:
Gender:F
Credentials:MS RD CDN
Other - Prefix:MS
Other - First Name:RITA
Other - Middle Name:H
Other - Last Name:SHAH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:825 VAN BUREN ST
Mailing Address - Street 2:
Mailing Address - City:BALDWIN HARBOR
Mailing Address - State:NY
Mailing Address - Zip Code:11510-4653
Mailing Address - Country:US
Mailing Address - Phone:516-868-0605
Mailing Address - Fax:
Practice Address - Street 1:825 VAN BUREN ST
Practice Address - Street 2:
Practice Address - City:BALDWIN HARBOR
Practice Address - State:NY
Practice Address - Zip Code:11510-4653
Practice Address - Country:US
Practice Address - Phone:516-868-0605
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001751133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03P471Medicare ID - Type Unspecified