Healthcare Provider Details

I. General information

NPI: 1730761040
Provider Name (Legal Business Name): JENNIFER B GOLDSTEIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2021
Last Update Date: 04/26/2021
Certification Date: 04/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1315 JEFFERSON HWY
NEW ORLEANS LA
70121-2406
US

IV. Provider business mailing address

14902 ROYALBROOK DR
CHESTERFIELD MO
63017-7722
US

V. Phone/Fax

Practice location:
  • Phone: 504-842-3900
  • Fax:
Mailing address:
  • Phone: 636-577-4557
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: