Provider Demographics
NPI:1356778864
Name:KRAWEC, CODY TULLY (RD)
Entity type:Individual
Prefix:MR
First Name:CODY
Middle Name:TULLY
Last Name:KRAWEC
Suffix:
Gender:M
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1211 STEWART AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:BETHPAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11714-1601
Mailing Address - Country:US
Mailing Address - Phone:516-348-1480
Mailing Address - Fax:
Practice Address - Street 1:1211 STEWART AVE STE 100
Practice Address - Street 2:
Practice Address - City:BETHPAGE
Practice Address - State:NY
Practice Address - Zip Code:11714-1601
Practice Address - Country:US
Practice Address - Phone:516-348-1480
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-28
Last Update Date:2013-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY86014762133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered