Healthcare Provider Details

I. General information

NPI: 1750183521
Provider Name (Legal Business Name): TARA ANN KOHL RDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2025
Last Update Date: 03/25/2025
Certification Date: 03/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7239 BERGEN CT
BROOKLYN NY
11234-5890
US

IV. Provider business mailing address

7239 BERGEN CT
BROOKLYN NY
11234-5890
US

V. Phone/Fax

Practice location:
  • Phone: 646-610-0135
  • Fax:
Mailing address:
  • Phone: 646-610-0135
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86148574
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: