Provider Demographics
NPI:1568530541
Name:RICHARDSON, GEORGIA S (RD,CDE)
Entity Type:Individual
Prefix:
First Name:GEORGIA
Middle Name:S
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:RD,CDE
Other - Prefix:
Other - First Name:GEORGIA
Other - Middle Name:S
Other - Last Name:NUGENT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RD,CDE
Mailing Address - Street 1:55 WATER ST FL 12
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10041-0004
Mailing Address - Country:US
Mailing Address - Phone:646-680-2888
Mailing Address - Fax:516-542-5556
Practice Address - Street 1:2832 LINDEN BOULEVARD
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11208
Practice Address - Country:US
Practice Address - Phone:718-240-2000
Practice Address - Fax:718-240-2215
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2017-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001981133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY001981OtherLICENSE NUMBER