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NPI Code Detail

MEDICARE: MS. ANNE REBECCA GOODMAN RD, CDE

MEDICARE: MS. ANNE REBECCA GOODMAN RD, CDE
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1133V00000XRegistered Dietitian005971-1NY

General Provider Information

NPI Number : 1104111814
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. ANNE REBECCA GOODMAN RD, CDE
Provider Business Mailing Address
First Line : 922 PRESIDENT ST
Second Line :
City : BROOKLYN
State : NY
Zip : 11215-1695
Country : US
Telephone Number : 718-399-2128
Fax Number :
Provider Business Practice Location Address
First Line : 803 STERLING PL
Second Line :
City : BROOKLYN
State : NY
Zip : 11216-3903
Country : US
Telephone Number : 718-804-0900
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/10/2011
Last Update Date : 06/10/2011

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