Provider Demographics
NPI:1396783502
Name:FASSBERG, ELIZABETH (RD)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:FASSBERG
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:242 E 60TH ST
Mailing Address - Street 2:#2R
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-1453
Mailing Address - Country:US
Mailing Address - Phone:212-980-9828
Mailing Address - Fax:212-980-9828
Practice Address - Street 1:242 E 60TH ST
Practice Address - Street 2:#2R
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-1453
Practice Address - Country:US
Practice Address - Phone:212-980-9828
Practice Address - Fax:212-980-9828
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5587133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered