Provider Demographics
NPI:1487102901
Name:GOLDBRENNER, CHANA (MS, CNS)
Entity type:Individual
Prefix:MRS
First Name:CHANA
Middle Name:
Last Name:GOLDBRENNER
Suffix:
Gender:F
Credentials:MS, CNS
Other - Prefix:MRS
Other - First Name:HELENE
Other - Middle Name:CHANA
Other - Last Name:GOLDBRENNER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS, CNS
Mailing Address - Street 1:542 ARLINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-4817
Mailing Address - Country:US
Mailing Address - Phone:732-952-2013
Mailing Address - Fax:
Practice Address - Street 1:542 ARLINGTON AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-4817
Practice Address - Country:US
Practice Address - Phone:732-952-2013
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-13
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education