Provider Demographics
NPI:1982841235
Name:HOLEWA, KELLY J (MPH, RD)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:J
Last Name:HOLEWA
Suffix:
Gender:F
Credentials:MPH, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:261 E 78TH ST FL 6
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10075-1201
Mailing Address - Country:US
Mailing Address - Phone:646-386-7745
Mailing Address - Fax:
Practice Address - Street 1:261 E 78TH ST FL 6
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10075-1201
Practice Address - Country:US
Practice Address - Phone:646-386-7745
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-08
Last Update Date:2012-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007010133V00000X
NC0977415133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered