Provider Demographics
NPI:1588453963
Name:GOODMAN, ILANA (RDN)
Entity type:Individual
Prefix:
First Name:ILANA
Middle Name:
Last Name:GOODMAN
Suffix:
Gender:
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:923 JUNIPER WAY
Mailing Address - Street 2:
Mailing Address - City:MAHWAH
Mailing Address - State:NJ
Mailing Address - Zip Code:07430-3466
Mailing Address - Country:US
Mailing Address - Phone:845-323-1030
Mailing Address - Fax:
Practice Address - Street 1:923 JUNIPER WAY
Practice Address - Street 2:
Practice Address - City:MAHWAH
Practice Address - State:NJ
Practice Address - Zip Code:07430-3466
Practice Address - Country:US
Practice Address - Phone:845-323-1030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-02
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
837417133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered