Provider Demographics
NPI:1144764630
Name:MASTERSON, ERICA (MS RD CDN)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:MASTERSON
Suffix:
Gender:F
Credentials:MS RD CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3050 ROUTE 50
Mailing Address - Street 2:NUTRITIONAL SERVICES-2ND FLOOR
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:12866-2958
Mailing Address - Country:US
Mailing Address - Phone:518-886-5121
Mailing Address - Fax:518-886-5857
Practice Address - Street 1:3050 ROUTE 50
Practice Address - Street 2:NUTRITIONAL SERVICES-2ND FLOOR
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:12866-2958
Practice Address - Country:US
Practice Address - Phone:518-886-5121
Practice Address - Fax:518-886-5857
Is Sole Proprietor?:No
Enumeration Date:2016-12-19
Last Update Date:2016-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008178133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist