Provider Demographics
NPI:1538299243
Name:KRONBERG, SONDRA (MS RD CDN CEDRD)
Entity Type:Individual
Prefix:
First Name:SONDRA
Middle Name:
Last Name:KRONBERG
Suffix:
Gender:F
Credentials:MS RD CDN CEDRD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:366 N BROADWAY
Mailing Address - Street 2:STE PHW-1
Mailing Address - City:JERICHO
Mailing Address - State:NY
Mailing Address - Zip Code:11753-2025
Mailing Address - Country:US
Mailing Address - Phone:516-513-1284
Mailing Address - Fax:516-513-1285
Practice Address - Street 1:366 N BROADWAY
Practice Address - Street 2:STE PHW-1
Practice Address - City:JERICHO
Practice Address - State:NY
Practice Address - Zip Code:11753-2025
Practice Address - Country:US
Practice Address - Phone:516-513-1284
Practice Address - Fax:516-513-1285
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2014-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY48000391133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered