Provider Demographics
NPI:1689114183
Name:IZBICKI, GINA MARIE (RD, LDN)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:MARIE
Last Name:IZBICKI
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 FRONT ST STE 209
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:MA
Mailing Address - Zip Code:01970-3743
Mailing Address - Country:US
Mailing Address - Phone:978-927-0990
Mailing Address - Fax:866-921-9387
Practice Address - Street 1:16 FRONT ST STE 209
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970-3743
Practice Address - Country:US
Practice Address - Phone:978-927-0990
Practice Address - Fax:866-921-9387
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-02
Last Update Date:2021-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4166133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered