Basic Information
| Provider Information | |||||||||
| NPI: | 1144764630 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MASTERSON | ||||||||
| FirstName: | ERICA | ||||||||
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| Credential: | MS RD CDN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3050 ROUTE 50 | ||||||||
| Address2: | NUTRITIONAL SERVICES-2ND FLOOR | ||||||||
| City: | SARATOGA SPRINGS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 128662958 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5188865121 | ||||||||
| FaxNumber: | 5188865857 | ||||||||
| Practice Location | |||||||||
| Address1: | 3050 ROUTE 50 | ||||||||
| Address2: | NUTRITIONAL SERVICES-2ND FLOOR | ||||||||
| City: | SARATOGA SPRINGS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 128662958 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5188865121 | ||||||||
| FaxNumber: | 5188865857 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/19/2016 | ||||||||
| LastUpdateDate: | 12/19/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133N00000X | 008178 | NY | Y | Dietary & Nutritional Service Providers | Nutritionist |
No ID Information.