Provider Demographics
NPI:1801948641
Name:AYOOB, KEITH THOMAS (EDD, RD, CDN)
Entity type:Individual
Prefix:DR
First Name:KEITH
Middle Name:THOMAS
Last Name:AYOOB
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Gender:M
Credentials:EDD, RD, CDN
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Mailing Address - Street 1:212 E 47TH ST
Mailing Address - Street 2:18F
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10017-2128
Mailing Address - Country:US
Mailing Address - Phone:718-430-3970
Mailing Address - Fax:718-823-4877
Practice Address - Street 1:1165 MORRIS PARK AVE
Practice Address - Street 2:ROOM 438
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-1915
Practice Address - Country:US
Practice Address - Phone:718-430-3970
Practice Address - Fax:718-823-4877
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2014-11-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY002276-1133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered