Provider Demographics
NPI:1659401941
Name:GOLDNER, SUSAN (RD CDN)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:GOLDNER
Suffix:
Gender:F
Credentials:RD CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1602 52ND ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11204-1418
Mailing Address - Country:US
Mailing Address - Phone:718-854-5784
Mailing Address - Fax:866-871-8449
Practice Address - Street 1:1602 52ND ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11204-1418
Practice Address - Country:US
Practice Address - Phone:718-854-5784
Practice Address - Fax:866-871-8449
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005941-1133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered