Provider Demographics
NPI:1659420081
Name:WACHTEL, NINA (RD)
Entity Type:Individual
Prefix:
First Name:NINA
Middle Name:
Last Name:WACHTEL
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 1:400 TITUS WAY
Mailing Address - Street 2:
Mailing Address - City:EAST WILLISTON
Mailing Address - State:NY
Mailing Address - Zip Code:11596-2539
Mailing Address - Country:US
Mailing Address - Phone:516-746-0553
Mailing Address - Fax:516-746-0553
Practice Address - Street 1:400 TITUS WAY
Practice Address - Street 2:
Practice Address - City:EAST WILLISTON
Practice Address - State:NY
Practice Address - Zip Code:11596-2539
Practice Address - Country:US
Practice Address - Phone:516-746-0553
Practice Address - Fax:516-746-0553
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002320133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP1941384OtherOXFORD