Healthcare Provider Details

I. General information

NPI: 1457544058
Provider Name (Legal Business Name): WENDY BROOKE GOLDMAN RD, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2007
Last Update Date: 08/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

930 TOWN CENTER DR SUITE G-100
LANGHORNE PA
19047-3503
US

IV. Provider business mailing address

1516 CORSLEY CT
MAPLE GLEN PA
19002-3137
US

V. Phone/Fax

Practice location:
  • Phone: 215-750-9831
  • Fax: 215-750-9837
Mailing address:
  • Phone: 215-628-0394
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1005X
TaxonomyRenal Nutrition Registered Dietitian
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDN001347
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: