Provider Demographics
NPI:1699177485
Name:GORMAN, EMILY CATHERINE (RD, CDN)
Entity Type:Individual
Prefix:MISS
First Name:EMILY
Middle Name:CATHERINE
Last Name:GORMAN
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 1:50 SCHOOL ST
Mailing Address - Street 2:APT. 11
Mailing Address - City:LANCASTER
Mailing Address - State:NY
Mailing Address - Zip Code:14086-2251
Mailing Address - Country:US
Mailing Address - Phone:716-715-3762
Mailing Address - Fax:
Practice Address - Street 1:1084 DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14209
Practice Address - Country:US
Practice Address - Phone:716-715-3762
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-23
Last Update Date:2014-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY01065786133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered