Provider Demographics
NPI:1760521488
Name:WERBER, SHOSHANA SUZANNE (MS, RD, CDN)
Entity Type:Individual
Prefix:MS
First Name:SHOSHANA
Middle Name:SUZANNE
Last Name:WERBER
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 1:262 CENTRAL PARK W
Mailing Address - Street 2:SUITE 1 E
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-3512
Mailing Address - Country:US
Mailing Address - Phone:212-799-2986
Mailing Address - Fax:212-362-8738
Practice Address - Street 1:262 CENTRAL PARK W
Practice Address - Street 2:SUITE 1 E
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-3512
Practice Address - Country:US
Practice Address - Phone:212-799-2986
Practice Address - Fax:212-362-8738
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006232133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered