Provider Demographics
NPI:1205149259
Name:GILBERT, KEREN (MS, RD)
Entity type:Individual
Prefix:MRS
First Name:KEREN
Middle Name:
Last Name:GILBERT
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 SYCAMORE LN
Mailing Address - Street 2:
Mailing Address - City:ROSLYN HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11577-2522
Mailing Address - Country:US
Mailing Address - Phone:516-939-9090
Mailing Address - Fax:516-484-4451
Practice Address - Street 1:36 SYCAMORE LN
Practice Address - Street 2:
Practice Address - City:ROSLYN HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11577-2522
Practice Address - Country:US
Practice Address - Phone:516-939-9090
Practice Address - Fax:516-484-4451
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-20
Last Update Date:2016-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005095-1133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered