Provider Demographics
NPI:1861133191
Name:PODESWIK, SOPHIE (RDN)
Entity type:Individual
Prefix:MISS
First Name:SOPHIE
Middle Name:
Last Name:PODESWIK
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:424 E 11TH ST APT 18
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10009-4549
Mailing Address - Country:US
Mailing Address - Phone:619-403-1880
Mailing Address - Fax:
Practice Address - Street 1:424 E 11TH ST APT 18
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10009-4549
Practice Address - Country:US
Practice Address - Phone:619-403-1880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-01
Last Update Date:2022-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
86151888133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
86151888OtherREGISTERED DIETITIAN