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NPI Code Detail

MEDICARE: MRS. ILLANA MATZ-KHROMCHENKO MS, RD

MEDICARE: MRS. ILLANA MATZ-KHROMCHENKO MS, RD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1133V00000XRegistered Dietitian005384NY

General Provider Information

NPI Number : 1326136136
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. ILLANA MATZ-KHROMCHENKO MS, RD
Provider Business Mailing Address
First Line : 11 HEDGEROW LN
Second Line :
City : MANALAPAN
State : NJ
Zip : 07726-7905
Country : US
Telephone Number : 718-646-8700
Fax Number : 718-646-8726
Provider Business Practice Location Address
First Line : 3065 BRIGHTON 14TH ST
Second Line :
City : BROOKLYN
State : NY
Zip : 11235-5501
Country : US
Telephone Number : 718-646-8700
Fax Number : 718-646-8726
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/10/2006
Last Update Date : 07/08/2007

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