Provider Demographics
NPI:1891265104
Name:GOLDMAN, ELLEN R (RD/LDN)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:R
Last Name:GOLDMAN
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 1:8 SILSBEE ST
Mailing Address - Street 2:
Mailing Address - City:LYNN
Mailing Address - State:MA
Mailing Address - Zip Code:01901-1404
Mailing Address - Country:US
Mailing Address - Phone:781-586-8688
Mailing Address - Fax:
Practice Address - Street 1:8 SILSBEE ST
Practice Address - Street 2:
Practice Address - City:LYNN
Practice Address - State:MA
Practice Address - Zip Code:01901-1404
Practice Address - Country:US
Practice Address - Phone:781-586-8688
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-29
Last Update Date:2018-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered