Provider Demographics
NPI:1184050221
Name:LUCKMAN, RANDI (MS,CPC, CHC, CM)
Entity type:Individual
Prefix:
First Name:RANDI
Middle Name:
Last Name:LUCKMAN
Suffix:
Gender:F
Credentials:MS,CPC, CHC, CM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 KAPPOCK ST
Mailing Address - Street 2:# 1015
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-4612
Mailing Address - Country:US
Mailing Address - Phone:917-763-4111
Mailing Address - Fax:
Practice Address - Street 1:750 KAPPOCK ST
Practice Address - Street 2:#1015
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-4612
Practice Address - Country:US
Practice Address - Phone:917-763-4111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-20
Last Update Date:2013-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
No133N00000XDietary & Nutritional Service ProvidersNutritionist