Provider Demographics
NPI:1154163806
Name:FICKENSCHER, JULIA (RDN)
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:
Last Name:FICKENSCHER
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:229 E 87TH ST APT 2W
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-3253
Mailing Address - Country:US
Mailing Address - Phone:805-766-2081
Mailing Address - Fax:
Practice Address - Street 1:229 E 87TH ST APT 2W
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-3253
Practice Address - Country:US
Practice Address - Phone:805-766-2081
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-12
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011602133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered