Provider Demographics
NPI:1386155471
Name:KATZ, JOAN LESLEY (RDN)
Entity type:Individual
Prefix:MS
First Name:JOAN
Middle Name:LESLEY
Last Name:KATZ
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 1:206 ADMIRALS WAY
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19146-5212
Mailing Address - Country:US
Mailing Address - Phone:201-788-1694
Mailing Address - Fax:215-732-2564
Practice Address - Street 1:206 ADMIRALS WAY
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19146-1914
Practice Address - Country:US
Practice Address - Phone:201-788-1694
Practice Address - Fax:201-788-1694
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-17
Last Update Date:2017-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN006259133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered