MEDICARE: MRS. CHANA GOLDBRENNER MS, CNS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133N00000X	Nutritionist
2	133NN1002X	Nutrition Education Nutritionist

General Provider Information

NPI Number	:	1487102901
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CHANA GOLDBRENNER MS, CNS

Provider Business Mailing Address
First Line	:	542 ARLINGTON AVE
Second Line	:
City	:	LAKEWOOD
State	:	NJ
Zip	:	08701-4817
Country	:	US
Telephone Number	:	732-952-2013
Fax Number	:

Provider Business Practice Location Address
First Line	:	542 ARLINGTON AVE
Second Line	:
City	:	LAKEWOOD
State	:	NJ
Zip	:	08701-4817
Country	:	US
Telephone Number	:	732-952-2013
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/13/2016
Last Update Date	:	01/25/2017

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