Provider Demographics
NPI:1457536096
Name:FREDERICKS, NADIA N (RD)
Entity Type:Individual
Prefix:
First Name:NADIA
Middle Name:N
Last Name:FREDERICKS
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1981 MARCUS AVE
Mailing Address - Street 2:SUITE 208
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11042-1038
Mailing Address - Country:US
Mailing Address - Phone:212-746-0838
Mailing Address - Fax:516-437-4167
Practice Address - Street 1:525 E 68TH ST
Practice Address - Street 2:GREENBERG PAVILION RM 10-171
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-4870
Practice Address - Country:US
Practice Address - Phone:212-746-0838
Practice Address - Fax:516-437-4167
Is Sole Proprietor?:No
Enumeration Date:2008-01-02
Last Update Date:2008-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006352133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY006352OtherLICENSE NUMBER