Provider Demographics
NPI:1386952281
Name:VICTORIA GOODMAN
Entity type:Organization
Organization Name:VICTORIA GOODMAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:GOODMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MS,RD,LDN
Authorized Official - Phone:215-920-4656
Mailing Address - Street 1:1844 BEACON HILL DR
Mailing Address - Street 2:
Mailing Address - City:DRESHER
Mailing Address - State:PA
Mailing Address - Zip Code:19025-1412
Mailing Address - Country:US
Mailing Address - Phone:215-920-4656
Mailing Address - Fax:
Practice Address - Street 1:1844 BEACON HILL DR
Practice Address - Street 2:
Practice Address - City:DRESHER
Practice Address - State:PA
Practice Address - Zip Code:19025-1412
Practice Address - Country:US
Practice Address - Phone:215-920-4656
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-14
Last Update Date:2010-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty