Provider Demographics
NPI:1104567601
Name:GOODSTADT, MORGAN BOKER-PORPORA (MS, RD, CDN, LDN)
Entity type:Individual
Prefix:
First Name:MORGAN
Middle Name:BOKER-PORPORA
Last Name:GOODSTADT
Suffix:
Gender:F
Credentials:MS, RD, CDN, LDN
Other - Prefix:
Other - First Name:MORGAN
Other - Middle Name:
Other - Last Name:BOKER-PORPORA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, RD, LDN
Mailing Address - Street 1:14060 PANAY WAY APT 105
Mailing Address - Street 2:
Mailing Address - City:MARINA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90292-7534
Mailing Address - Country:US
Mailing Address - Phone:914-494-6654
Mailing Address - Fax:
Practice Address - Street 1:14060 PANAY WAY APT 105
Practice Address - Street 2:
Practice Address - City:MARINA DEL REY
Practice Address - State:CA
Practice Address - Zip Code:90292-7534
Practice Address - Country:US
Practice Address - Phone:914-494-6654
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-06
Last Update Date:2024-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL10696133V00000X
NY011063133V00000X
86171608133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL10696OtherFLORIDA LDN IDENTIFICATION
86171608OtherCDR IDENTIFICATION
NY011063OtherNEW YORK CDN