Provider Demographics
NPI:1447451653
Name:STELMARK, CARMEN M (NUTRITIONIST)
Entity type:Individual
Prefix:MRS
First Name:CARMEN
Middle Name:M
Last Name:STELMARK
Suffix:
Gender:F
Credentials:NUTRITIONIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2533 86TH ST STE A
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11214-4414
Mailing Address - Country:US
Mailing Address - Phone:718-680-2978
Mailing Address - Fax:718-491-2450
Practice Address - Street 1:2533 86TH ST STE A
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11214-4414
Practice Address - Country:US
Practice Address - Phone:718-680-2978
Practice Address - Fax:718-491-2450
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002016-1133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist