Provider Demographics
NPI:1396539276
Name:ILANA KERSCH NUTRITION PLLC
Entity type:Organization
Organization Name:ILANA KERSCH NUTRITION PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ILANA
Authorized Official - Middle Name:
Authorized Official - Last Name:KERSCH
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:516-524-7319
Mailing Address - Street 1:28 NEWELL ST APT 2B
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11222-4053
Mailing Address - Country:US
Mailing Address - Phone:516-524-7319
Mailing Address - Fax:516-524-7319
Practice Address - Street 1:28 NEWELL ST APT 2B
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11222-4053
Practice Address - Country:US
Practice Address - Phone:516-524-7319
Practice Address - Fax:516-524-7319
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-07
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1528437761Medicaid