Provider Demographics
NPI:1730482753
Name:KOLTUN, AUDREY (RD)
Entity Type:Individual
Prefix:
First Name:AUDREY
Middle Name:
Last Name:KOLTUN
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 1:21 DONNA DR
Mailing Address - Street 2:
Mailing Address - City:PLAINVIEW
Mailing Address - State:NY
Mailing Address - Zip Code:11803-3101
Mailing Address - Country:US
Mailing Address - Phone:516-938-5912
Mailing Address - Fax:516-470-4565
Practice Address - Street 1:21 DONNA DR
Practice Address - Street 2:
Practice Address - City:PLAINVIEW
Practice Address - State:NY
Practice Address - Zip Code:11803-3101
Practice Address - Country:US
Practice Address - Phone:516-938-5912
Practice Address - Fax:516-470-4565
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-14
Last Update Date:2010-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered