Healthcare Provider Details

I. General information

NPI: 1568530541
Provider Name (Legal Business Name): GEORGIA S RICHARDSON RD,CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: GEORGIA S NUGENT RD,CDE

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 11/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2832 LINDEN BOULEVARD
BROOKLYN NY
11208
US

IV. Provider business mailing address

55 WATER ST FL 12
NEW YORK NY
10041-0004
US

V. Phone/Fax

Practice location:
  • Phone: 718-240-2000
  • Fax: 718-240-2215
Mailing address:
  • Phone: 646-680-2888
  • Fax: 516-542-5556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number001981
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: