Provider Demographics
NPI:1992311872
Name:ILLIEN, CRISTINA VELTRI (RD)
Entity type:Individual
Prefix:MRS
First Name:CRISTINA
Middle Name:VELTRI
Last Name:ILLIEN
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 1:17 W 74TH ST APT 5A
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-2445
Mailing Address - Country:US
Mailing Address - Phone:917-375-2737
Mailing Address - Fax:
Practice Address - Street 1:17 W 74TH ST APT 5A
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-2445
Practice Address - Country:US
Practice Address - Phone:917-375-2737
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-16
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133V00000X
NY86143520133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered