MEDICARE: GE GE MS, RD, CDCES

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
1	133V00000X	Registered Dietitian

General Provider Information

NPI Number	:	1265112924
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GE GE MS, RD, CDCES

Provider Business Mailing Address
First Line	:	300 E 33RD ST APT 10P
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10016-9413
Country	:	US
Telephone Number	:	908-696-3504
Fax Number	:

Provider Business Practice Location Address
First Line	:	300 E 33RD ST APT 10P
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10016-9413
Country	:	US
Telephone Number	:	908-696-3504
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/18/2023
Last Update Date	:	07/18/2023

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