Healthcare Provider Details

I. General information

NPI: 1083039002
Provider Name (Legal Business Name): ROBYN KOTEK MS, RD, CDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2014
Last Update Date: 02/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1249 5TH AVE
NEW YORK NY
10029-4413
US

IV. Provider business mailing address

1249 5TH AVE
NEW YORK NY
10029-4413
US

V. Phone/Fax

Practice location:
  • Phone: 212-360-3703
  • Fax:
Mailing address:
  • Phone: 212-360-3703
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number007945
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number007945
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: