Provider Demographics
NPI:1144249616
Name:KATZ, ADRIENNE (MS,RD,CDN)
Entity type:Individual
Prefix:
First Name:ADRIENNE
Middle Name:
Last Name:KATZ
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 1:11 KEMP LN
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-3618
Mailing Address - Country:US
Mailing Address - Phone:516-741-8356
Mailing Address - Fax:516-741-8356
Practice Address - Street 1:11 KEMP LN
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11040-3618
Practice Address - Country:US
Practice Address - Phone:516-741-8356
Practice Address - Fax:516-741-8356
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000684-1133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYS02531Medicare ID - Type UnspecifiedPROVIDER NUMBER