Provider Demographics
NPI:1285459586
Name:GREEN, ESTHER GOLDA (RDN)
Entity type:Individual
Prefix:MRS
First Name:ESTHER
Middle Name:GOLDA
Last Name:GREEN
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1321 E 12TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-5803
Mailing Address - Country:US
Mailing Address - Phone:917-504-7409
Mailing Address - Fax:
Practice Address - Street 1:1648 E 14TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-1191
Practice Address - Country:US
Practice Address - Phone:347-746-0543
Practice Address - Fax:736-347-0547
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-21
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY86291895133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered