Provider Demographics
NPI:1841537453
Name:PRITZKER, SHOSHANA (RD)
Entity type:Individual
Prefix:
First Name:SHOSHANA
Middle Name:
Last Name:PRITZKER
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:EAST ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11730-2009
Mailing Address - Country:US
Mailing Address - Phone:407-808-6059
Mailing Address - Fax:631-775-7636
Practice Address - Street 1:10 1ST AVE
Practice Address - Street 2:
Practice Address - City:EAST ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11730-2009
Practice Address - Country:US
Practice Address - Phone:407-808-6059
Practice Address - Fax:631-775-7636
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-16
Last Update Date:2014-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007578133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist