Provider Demographics
NPI:1578341616
Name:KOENIG, DANA
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:
Last Name:KOENIG
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 1:1500 TEANECK RD APT 431
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-3659
Mailing Address - Country:US
Mailing Address - Phone:847-899-5744
Mailing Address - Fax:
Practice Address - Street 1:720 MONROE ST STE E512
Practice Address - Street 2:
Practice Address - City:HOBOKEN
Practice Address - State:NJ
Practice Address - Zip Code:07030-6360
Practice Address - Country:US
Practice Address - Phone:917-647-1665
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-19
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011439133V00000X
NJ86197922133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered