Provider Demographics
NPI:1629352687
Name:GOLDSTEIN, ELIZABETH (MS, RD, CDN)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:GOLDSTEIN
Suffix:
Gender:F
Credentials:MS, RD, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 E 82ND ST APT 10D
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-2735
Mailing Address - Country:US
Mailing Address - Phone:646-242-8109
Mailing Address - Fax:
Practice Address - Street 1:240 E 82ND ST APT 10D
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-2735
Practice Address - Country:US
Practice Address - Phone:646-242-8109
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-07
Last Update Date:2011-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered