Active NPI
Imma Normatova, MS, RD, CLC
- Registered Dietitian
- Rego Park, NY
National Provider Identifier
1669847232
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 1091516
- Practice address
- 9822 63Rd Dr Apt 2E
Rego Park, NY 11374-2301 - Phone
- (718) 532-6241
- NPI assigned
- Dec 8, 2015
- Last updated
- Dec 8, 2015
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 1091516 | NY | Primary |
Addresses
Primary practice location
9822 63Rd Dr Apt 2E
Rego Park, NY 11374-2301
Mailing address
9822 63Rd Dr Apt 2E
Rego Park, NY 11374-2301
Phone (718) 532-6241
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1091516 | NY | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1449532800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1449532800000",
"number": "1669847232",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9822 63RD DR APT 2E",
"city": "REGO PARK",
"state": "NY",
"postal_code": "113742301",
"telephone_number": "718-532-6241"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9822 63RD DR APT 2E",
"city": "REGO PARK",
"state": "NY",
"postal_code": "113742301",
"telephone_number": "718-532-6241"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NORMATOVA",
"first_name": "IMMA",
"name_prefix": "Mrs.",
"credential": "MS, RD, CLC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-12-08",
"last_updated": "2015-12-08",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "NY",
"license": "1091516",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Rego Park, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.