Provider Demographics
NPI:1902294168
Name:GERTSENSHTEYN, SVETLANA (PHD, MPH, RD, CDN)
Entity Type:Individual
Prefix:DR
First Name:SVETLANA
Middle Name:
Last Name:GERTSENSHTEYN
Suffix:
Gender:F
Credentials:PHD, MPH, RD, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1245 E 35TH ST FL 2
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11210-4821
Mailing Address - Country:US
Mailing Address - Phone:917-615-6534
Mailing Address - Fax:
Practice Address - Street 1:1245 E 35TH ST FL 2
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11210-4821
Practice Address - Country:US
Practice Address - Phone:917-615-6534
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-22
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000667-1133V00000X
NY816548133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered