Provider Demographics
NPI:1275224495
Name:SCHWARTZ, SHOSHANA (RD CDN)
Entity Type:Individual
Prefix:
First Name:SHOSHANA
Middle Name:
Last Name:SCHWARTZ
Suffix:
Gender:F
Credentials:RD CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1775 WINDSOR RD APT 321
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-3072
Mailing Address - Country:US
Mailing Address - Phone:646-708-1175
Mailing Address - Fax:
Practice Address - Street 1:1775 WINDSOR RD APT 321
Practice Address - Street 2:
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-3072
Practice Address - Country:US
Practice Address - Phone:646-708-1175
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-18
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1032766133NN1002X, 133VN1005X, 133VN1006X, 133VN1101X, 133VN1301X, 133VN1201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1201XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Obesity and Weight Management
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
No133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal
No133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic
No133VN1101XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Gerontological
No133VN1301XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Oncology