Provider Demographics
NPI:1891947156
Name:BLACKSBURG, ERICA (MS, RD, CDN)
Entity Type:Individual
Prefix:MS
First Name:ERICA
Middle Name:
Last Name:BLACKSBURG
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 1:14 WALL ST
Mailing Address - Street 2:SUITE 1100C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10005-2101
Mailing Address - Country:US
Mailing Address - Phone:347-761-3198
Mailing Address - Fax:
Practice Address - Street 1:14 WALL ST
Practice Address - Street 2:SUITE 1100C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10005-2101
Practice Address - Country:US
Practice Address - Phone:347-761-3198
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-17
Last Update Date:2010-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY849910133V00000X, 133VN1004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY849910OtherNY STATE EDUCATION DEPT- CERTIFIED DIETITIAN NUTRITIONIST