Provider Demographics
NPI:1801307723
Name:GORMAN-PLUTZER, MINDY (HHC, CEPC)
Entity type:Individual
Prefix:
First Name:MINDY
Middle Name:
Last Name:GORMAN-PLUTZER
Suffix:
Gender:F
Credentials:HHC, CEPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:74 E 79TH ST APT 5A
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10075-0266
Mailing Address - Country:US
Mailing Address - Phone:646-726-4084
Mailing Address - Fax:212-838-0863
Practice Address - Street 1:74 E 79TH ST APT 5A
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10075-0266
Practice Address - Country:US
Practice Address - Phone:646-726-4084
Practice Address - Fax:212-838-0863
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-18
Last Update Date:2017-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY94793205133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist