Provider Demographics
NPI:1720355738
Name:CADLAON, GERALDINE A
Entity Type:Individual
Prefix:
First Name:GERALDINE
Middle Name:A
Last Name:CADLAON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2079 FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10303-1735
Mailing Address - Country:US
Mailing Address - Phone:718-815-6560
Mailing Address - Fax:718-815-6570
Practice Address - Street 1:2079 FOREST AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10303-1735
Practice Address - Country:US
Practice Address - Phone:718-815-6560
Practice Address - Fax:718-815-6570
Is Sole Proprietor?:No
Enumeration Date:2011-11-18
Last Update Date:2011-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist