Healthcare Provider Details

I. General information

NPI: 1396113031
Provider Name (Legal Business Name): ANNETTE MOSER GOLDBERG RDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2015
Last Update Date: 04/09/2020
Certification Date: 04/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 SHAWMUT AVE APT 2
BOSTON MA
02118-2149
US

IV. Provider business mailing address

225 SHAWMUT AVE APT 2
BOSTON MA
02118-2149
US

V. Phone/Fax

Practice location:
  • Phone: 774-423-4623
  • Fax:
Mailing address:
  • Phone: 774-423-4623
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number3633
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number3633
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number3633
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: