Provider Demographics
NPI:1760547491
Name:MARSHEL, JUDY (RD, CDN)
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:
Last Name:MARSHEL
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 1:25 PARK PL
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-5015
Mailing Address - Country:US
Mailing Address - Phone:516-487-2755
Mailing Address - Fax:516-487-2755
Practice Address - Street 1:25 PARK PL
Practice Address - Street 2:1R
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-5015
Practice Address - Country:US
Practice Address - Phone:516-487-2755
Practice Address - Fax:516-487-2755
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000178-1133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1U1841Medicare ID - Type UnspecifiedPROVIDER NUMBER