Provider Demographics
NPI:1194244418
Name:COEN, CHRISTINE (RD)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:COEN
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:143 HUNTER RIDGE RD N
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-2708
Mailing Address - Country:US
Mailing Address - Phone:516-242-1866
Mailing Address - Fax:
Practice Address - Street 1:143 HUNTER RIDGE RD N
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-2708
Practice Address - Country:US
Practice Address - Phone:516-242-1866
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-19
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133N00000X
NY1021951133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist