Healthcare Provider Details

I. General information

NPI: 1275224495
Provider Name (Legal Business Name): SHOSHANA SCHWARTZ RD CDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2023
Last Update Date: 05/18/2023
Certification Date: 05/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1775 WINDSOR RD APT 321
TEANECK NJ
07666-3072
US

IV. Provider business mailing address

1775 WINDSOR RD APT 321
TEANECK NJ
07666-3072
US

V. Phone/Fax

Practice location:
  • Phone: 646-708-1175
  • Fax:
Mailing address:
  • Phone: 646-708-1175
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number1032766
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code133VN1005X
TaxonomyRenal Nutrition Registered Dietitian
License Number1032766
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License Number1032766
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code133VN1101X
TaxonomyGerontological Nutrition Registered Dietitian
License Number1032766
License Number StateNY
# 5
Primary TaxonomyN
Taxonomy Code133VN1301X
TaxonomyOncology Nutrition Registered Dietitian
License Number1032766
License Number StateNY
# 6
Primary TaxonomyY
Taxonomy Code133VN1201X
TaxonomyObesity and Weight Management Nutrition Registered Dietitian
License Number1032766
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: