Healthcare Provider Details

I. General information

NPI: 1962644898
Provider Name (Legal Business Name): ANGELA KURTZ M.S., RD, CDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2009
Last Update Date: 03/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1428 MADISON AVE FIRST FLOOR
NEW YORK NY
10029-6508
US

IV. Provider business mailing address

ONE GUSTAVE LEVY PLACE BOX 1497
NEW YORK NY
10029
US

V. Phone/Fax

Practice location:
  • Phone: 212-241-4515
  • Fax: 212-241-9467
Mailing address:
  • Phone: 212-241-4515
  • Fax: 212-241-9467

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number006280-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: