Individual
KATHERINE ANTZOULATOS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DPM, RD, CDN
Contact information
Practice address
915 150TH ST, WHITESTONE, NY 11357-1653
(347) 642-0315
Mailing address
915 150TH ST, WHITESTONE, NY 11357-1653
(347) 642-0315
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
1000889
NY
213EP1101X
Primary Podiatric Medicine Podiatrist
Primary
N004198
NY
Other
Enumeration date
02/15/2019
Last updated
02/15/2019
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