Individual provider Active NPI

Irene M. Nicolaides, M.S., R.D. C.D.N.

  • Registered Dietitian
  • Astoria, NY
National Provider Identifier
1932174174
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered DietitianTaxonomy code 133V00000X
License
005735-1 Issued in NY
Practice address
2318 31St St
Suite 320
Astoria, NY 11105-2892
Phone
(718) 728-9822
Fax
(718) 728-2004
NPI assigned
Feb 21, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Dietitian 133V00000X 005735-1 NY Primary

Addresses

Primary practice location

2318 31St St
Suite 320
Astoria, NY 11105-2892

Mailing address

2318 31St St
Suite 320
Astoria, NY 11105-2892
Phone (718) 728-9822

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050316001047 NY Practitioner - Registered Dietitian Or Nutrition Professional 5395790927 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Registered Dietitian Or Nutrition Professional
Education
Other, 2001
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

23
31St 2ND FL
Astoria, NY 11105-2808

23 17
Astoria, NY 11105-2808

2317 31St St
Astoria, NY 11105-2808
Phone (516) 499-7090

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science

State licenses

LicenseStateTypeSpecialty
005735-1NYMDRegistered Dietitian
005735NYMDAcupuncturist

Practice roles

OrganizationSpecialtyStatusNew patients
Irene M. Nicolaides Inc. Dietitian, Registered CurrentSince Aug 14, 2016 Accepting new patients

Locations

2317 31st St
Astoria, NY 11105
Phone (516) 499-7090

2318 31st St
Ste 320
Astoria, NY 11105
Phone (718) 635-3222

2317 31st St
Fl 2
Astoria, NY 11105
Phone (516) 499-7090

Networks

  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H3359
  • Healthfirst Medicare Network H5989

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1140480000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1932174174",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2318 31ST ST",
            "address_2": "SUITE 320",
            "city": "ASTORIA",
            "state": "NY",
            "postal_code": "111052892",
            "telephone_number": "718-728-9822",
            "fax_number": "718-728-2004"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2318 31ST ST",
            "address_2": "SUITE 320",
            "city": "ASTORIA",
            "state": "NY",
            "postal_code": "111052892",
            "telephone_number": "718-728-9822",
            "fax_number": "718-728-2004"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NICOLAIDES",
        "first_name": "IRENE",
        "middle_name": "M.",
        "name_prefix": "Miss",
        "credential": "M.S., R.D. C.D.N.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-02-21",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "NY",
            "license": "005735-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Astoria, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.