Provider Demographics
NPI:1285799247
Name:KING, HARRIET R (RDN CDE CDN)
Entity type:Individual
Prefix:MISS
First Name:HARRIET
Middle Name:R
Last Name:KING
Suffix:
Gender:F
Credentials:RDN CDE CDN
Other - Prefix:MS
Other - First Name:JAHANDA
Other - Middle Name:H
Other - Last Name:KING
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RDN CDE
Mailing Address - Street 1:5615 AVENUE J
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-2511
Mailing Address - Country:US
Mailing Address - Phone:917-572-6949
Mailing Address - Fax:
Practice Address - Street 1:5615 AVE. J
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-2511
Practice Address - Country:US
Practice Address - Phone:917-572-6949
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2019-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002656133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY002656OtherNEW YORK STATE CERTIFICAT