Healthcare Provider Details

I. General information

NPI: 1053663955
Provider Name (Legal Business Name): NATALLIA LASTOVKA RD, CDCES, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2012
Last Update Date: 09/08/2023
Certification Date: 09/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

172 MIDDLETOWN BLVD STE 203
LANGHORNE PA
19047-1871
US

IV. Provider business mailing address

172 MIDDLETOWN BLVD STE 203
LANGHORNE PA
19047-1871
US

V. Phone/Fax

Practice location:
  • Phone: 215-716-1650
  • Fax: 215-600-3354
Mailing address:
  • Phone: 215-716-1650
  • Fax: 215-600-3354

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number1069849
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number1069849
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1069849
License Number StateNJ
# 4
Primary TaxonomyN
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number1069849
License Number StateNJ
# 5
Primary TaxonomyN
Taxonomy Code133VN1005X
TaxonomyRenal Nutrition Registered Dietitian
License Number1069849
License Number StateNJ
# 6
Primary TaxonomyN
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License Number1069849
License Number StateNJ
# 7
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDN004974
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: