Provider Demographics
NPI:1790553816
Name:CITRON, CLARA (RDN, LDN, CDN)
Entity Type:Individual
Prefix:
First Name:CLARA
Middle Name:
Last Name:CITRON
Suffix:
Gender:F
Credentials:RDN, LDN, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 E 72ND ST APT 10D
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-4509
Mailing Address - Country:US
Mailing Address - Phone:917-514-0569
Mailing Address - Fax:
Practice Address - Street 1:220 E 72ND ST APT 10D
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-4509
Practice Address - Country:US
Practice Address - Phone:917-514-0569
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-18
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011601133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered