Provider Demographics
NPI:1558551093
Name:GANZON, CHRISTINA HOLDEN (RD)
Entity Type:Individual
Prefix:MS
First Name:CHRISTINA
Middle Name:HOLDEN
Last Name:GANZON
Suffix:
Gender:F
Credentials:RD
Other - Prefix:MS
Other - First Name:CHRISTINA
Other - Middle Name:HOLDEN
Other - Last Name:GANZON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RD
Mailing Address - Street 1:3245 LAKE RD
Mailing Address - Street 2:
Mailing Address - City:SENECA FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:13148-9416
Mailing Address - Country:US
Mailing Address - Phone:315-568-0093
Mailing Address - Fax:
Practice Address - Street 1:3245 LAKE RD
Practice Address - Street 2:
Practice Address - City:SENECA FALLS
Practice Address - State:NY
Practice Address - Zip Code:13148-9416
Practice Address - Country:US
Practice Address - Phone:315-568-0093
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-31
Last Update Date:2007-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered