Provider Demographics
NPI:1598001281
Name:GODOWN, SAMANTHA A (RDN)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:A
Last Name:GODOWN
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 BAKER RD
Mailing Address - Street 2:
Mailing Address - City:PITTSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08867-4030
Mailing Address - Country:US
Mailing Address - Phone:908-268-4532
Mailing Address - Fax:
Practice Address - Street 1:12 BAKER RD
Practice Address - Street 2:
Practice Address - City:PITTSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08867-4030
Practice Address - Country:US
Practice Address - Phone:908-268-4532
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1074104133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered