Provider Demographics
NPI:1114624889
Name:JORGE, NOEMY (RD)
Entity Type:Individual
Prefix:
First Name:NOEMY
Middle Name:
Last Name:JORGE
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:NOEMY
Other - Middle Name:
Other - Last Name:JORGE CASTILLO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RD
Mailing Address - Street 1:495 W 186TH ST APT 2D
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10033-2913
Mailing Address - Country:US
Mailing Address - Phone:347-857-9988
Mailing Address - Fax:
Practice Address - Street 1:495 W 186TH ST APT 2D
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10033-2913
Practice Address - Country:US
Practice Address - Phone:347-857-9988
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-13
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1085176133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered