Provider Demographics
NPI:1588148936
Name:ROSENTHAL-TAWIL, IRAINA SAGE (RD)
Entity type:Individual
Prefix:
First Name:IRAINA
Middle Name:SAGE
Last Name:ROSENTHAL-TAWIL
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 1:1564 E 22ND ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11210-5125
Mailing Address - Country:US
Mailing Address - Phone:917-880-7108
Mailing Address - Fax:
Practice Address - Street 1:210 MONTROSE AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11206-2351
Practice Address - Country:US
Practice Address - Phone:347-987-2218
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-21
Last Update Date:2018-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY86115023OtherCDR