Provider Demographics
NPI:1932174174
Name:NICOLAIDES, IRENE M (MS, RD CDN)
Entity Type:Individual
Prefix:MISS
First Name:IRENE
Middle Name:M
Last Name:NICOLAIDES
Suffix:
Gender:F
Credentials:MS, RD CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2318 31ST ST
Mailing Address - Street 2:SUITE 320
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11105-2892
Mailing Address - Country:US
Mailing Address - Phone:718-728-9822
Mailing Address - Fax:718-728-2004
Practice Address - Street 1:2318 31ST ST
Practice Address - Street 2:SUITE 320
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11105-2892
Practice Address - Country:US
Practice Address - Phone:718-728-9822
Practice Address - Fax:718-728-2004
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005735-1133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered