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General NPI Number Information
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NPI Number | 1639577158
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Entity Type | Individual
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Provider Name | TRACY LOCKWOOD MS, RD, CDN
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Gender | Female
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Dates
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Enumeration Date | 12/16/2014
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Last Update Date | 12/18/2014
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Provider Practice Location Address
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Address Line | 330 W 58TH ST SUITE 414
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City | NEW YORK
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State | NY
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Zip | 10019-1827
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Country | US
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Telephone | 888-603-9228
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Fax |
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Provider Business Mailing Address
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Address Line | 2 TALL TREE LN
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City | PLEASANTVILLE
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State | NY
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Zip | 10570-1514
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 01082152
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License Number State | NY
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