Basic Information
| Provider Information | |||||||||
| NPI: | 1710249719 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GOODWIN | ||||||||
| FirstName: | DINA | ||||||||
| MiddleName: | |||||||||
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| Credential: | RD, CDN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 60 MADISON AVENUE | ||||||||
| Address2: | 5TH FLOOR | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100101600 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2125452439 | ||||||||
| FaxNumber: | 6463120481 | ||||||||
| Practice Location | |||||||||
| Address1: | 81 WEST 115TH STREET | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100263138 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2124260088 | ||||||||
| FaxNumber: | 2124268367 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/14/2012 | ||||||||
| LastUpdateDate: | 03/14/2018 | ||||||||
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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 | 133V00000X | 968573 | NY | N | Dietary & Nutritional Service Providers | Dietitian, Registered | 133V00000X | 008146 | NY | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.