Provider Demographics
NPI:1518198563
Name:GOLDSTEIN, LESLIE HOPE (RD)
Entity Type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:HOPE
Last Name:GOLDSTEIN
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 PINE TER
Mailing Address - Street 2:
Mailing Address - City:DEMAREST
Mailing Address - State:NJ
Mailing Address - Zip Code:07627-1211
Mailing Address - Country:US
Mailing Address - Phone:201-655-3365
Mailing Address - Fax:
Practice Address - Street 1:8100 KENNEDY BLVD
Practice Address - Street 2:
Practice Address - City:NORTH BERGEN
Practice Address - State:NJ
Practice Address - Zip Code:07047-4254
Practice Address - Country:US
Practice Address - Phone:201-655-3365
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-06
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133V00000X
NJ01025497133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered