Provider Demographics
NPI:1245380450
Name:GOLDBERG, JOCELYN MARLA (MS RD CDE CDN)
Entity Type:Individual
Prefix:MRS
First Name:JOCELYN
Middle Name:MARLA
Last Name:GOLDBERG
Suffix:
Gender:F
Credentials:MS RD CDE CDN
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:30 HEMPSTEAD AVE STE 154-L
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11570-4033
Mailing Address - Country:US
Mailing Address - Phone:516-593-1211
Mailing Address - Fax:516-593-2442
Practice Address - Street 1:30 HEMPSTEAD AVE STE 154-L
Practice Address - Street 2:
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570-4033
Practice Address - Country:US
Practice Address - Phone:516-593-1211
Practice Address - Fax:516-593-2442
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2020-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY824145133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY3857823003OtherCIGNA
NYP2574753OtherOXFORD
NY7097381OtherAETNA
NYJG003P742OtherBCBS
NY2191146OtherUNITED
NY03P741Medicare ID - Type Unspecified