Provider Demographics
NPI:1750791927
Name:KIMMEL, HADASSA (RDN, CDN)
Entity type:Individual
Prefix:
First Name:HADASSA
Middle Name:
Last Name:KIMMEL
Suffix:
Gender:F
Credentials:RDN, CDN
Other - Prefix:MRS
Other - First Name:HADASSA
Other - Middle Name:
Other - Last Name:LEMBERGER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RDN,CDN
Mailing Address - Street 1:766 EMPIRE AVE
Mailing Address - Street 2:
Mailing Address - City:FAR ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11691-4835
Mailing Address - Country:US
Mailing Address - Phone:917-538-8816
Mailing Address - Fax:
Practice Address - Street 1:766 EMPIRE AVE
Practice Address - Street 2:
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11691-4835
Practice Address - Country:US
Practice Address - Phone:917-538-8816
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-28
Last Update Date:2014-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008068133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered