Provider Demographics
NPI:1467568873
Name:GADOMSKI, THERESE M (RD,CDE,CDN)
Entity type:Individual
Prefix:MS
First Name:THERESE
Middle Name:M
Last Name:GADOMSKI
Suffix:
Gender:F
Credentials:RD,CDE,CDN
Other - Prefix:
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Mailing Address - Street 1:501 NEW KARNER RD
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12205-3882
Mailing Address - Country:US
Mailing Address - Phone:518-452-1337
Mailing Address - Fax:518-724-6660
Practice Address - Street 1:501 NEW KARNER RD
Practice Address - Street 2:SUITE 1A
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12205-3882
Practice Address - Country:US
Practice Address - Phone:518-452-1337
Practice Address - Fax:518-724-6660
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2008-10-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY005268133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY78189OtherGHI/HMO
NY10050420OtherCDPHP
NY000499470002OtherBSNENY
NY070125000023OtherFIDELIS
NY1G1011OtherEMPIRE BLUE CROSS
NY699492OtherMVP HEALTHCARE
NY699492OtherMVP HEALTHCARE