Provider Demographics
NPI:1912029950
Name:STRAIN, GLADYS WITT (PHD RD)
Entity Type:Individual
Prefix:DR
First Name:GLADYS
Middle Name:WITT
Last Name:STRAIN
Suffix:
Gender:F
Credentials:PHD RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:731 LADD RD
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10471-1203
Mailing Address - Country:US
Mailing Address - Phone:718-884-5779
Mailing Address - Fax:718-884-5779
Practice Address - Street 1:525 E 68TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-4870
Practice Address - Country:US
Practice Address - Phone:212-746-5661
Practice Address - Fax:212-746-8680
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000778-1133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYS0095Medicare ID - Type Unspecified