Provider Demographics
NPI:1689685935
Name:KATAN, NELLY (RD)
Entity Type:Individual
Prefix:MRS
First Name:NELLY
Middle Name:
Last Name:KATAN
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 1:8233 209TH ST
Mailing Address - Street 2:
Mailing Address - City:QUEENS VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11427-1307
Mailing Address - Country:US
Mailing Address - Phone:917-443-7430
Mailing Address - Fax:
Practice Address - Street 1:9876 QUEENS BLVD
Practice Address - Street 2:SUITE 1K
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-4356
Practice Address - Country:US
Practice Address - Phone:917-443-7430
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2019-04-12
Deactivation Date:2016-06-01
Deactivation Code:
Reactivation Date:2019-04-12
Provider Licenses
StateLicense IDTaxonomies
NY005598133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered