Provider Demographics
NPI:1710022983
Name:GOLDSON, GEORGETTE (MS RD CN)
Entity Type:Individual
Prefix:
First Name:GEORGETTE
Middle Name:
Last Name:GOLDSON
Suffix:
Gender:F
Credentials:MS RD CN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1041 E 222ND ST
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10469-1214
Mailing Address - Country:US
Mailing Address - Phone:718-652-3939
Mailing Address - Fax:845-564-6974
Practice Address - Street 1:1041 E 222ND ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10469-1214
Practice Address - Country:US
Practice Address - Phone:718-652-3939
Practice Address - Fax:845-564-6974
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003037-1133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY003037-1OtherNUTRITIONIST