Healthcare Provider Details

I. General information

NPI: 1952610511
Provider Name (Legal Business Name): JOANNA KRSULICH M.S., R.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JOANNA KRSULICH

II. Dates (important events)

Enumeration Date: 09/30/2010
Last Update Date: 09/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1055 SAW MILL RIVER RD
ARDSLEY NY
10502-1045
US

IV. Provider business mailing address

44 HUNGERFORD RD
BRIARCLIFF NY
10510-1310
US

V. Phone/Fax

Practice location:
  • Phone: 914-886-0024
  • Fax:
Mailing address:
  • Phone: 914-762-1662
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number005352-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: