Provider Demographics
NPI:1699730960
Name:JOE, HELEN L (RD)
Entity type:Individual
Prefix:
First Name:HELEN
Middle Name:L
Last Name:JOE
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 1:3007 208TH ST
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11360-2422
Mailing Address - Country:US
Mailing Address - Phone:718-225-0204
Mailing Address - Fax:718-225-0204
Practice Address - Street 1:9303 90TH AVENUE
Practice Address - Street 2:
Practice Address - City:WOODHAVEN
Practice Address - State:NY
Practice Address - Zip Code:11421
Practice Address - Country:US
Practice Address - Phone:718-850-1320
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003364133V00000X
NY622071133VN1005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Not Answered133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY07379Medicare ID - Type UnspecifiedMEDICAL NUTRITION THERAPY
NY9526E1Medicare ID - Type UnspecifiedMEDICAL NUTRITION THERAPY