Provider Demographics
NPI:1972263796
Name:GOLD, ELISE MARNI (RD)
Entity type:Individual
Prefix:MRS
First Name:ELISE
Middle Name:MARNI
Last Name:GOLD
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 1:401 GRIST MILL CIR
Mailing Address - Street 2:
Mailing Address - City:ROSLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11576-1639
Mailing Address - Country:US
Mailing Address - Phone:917-375-3883
Mailing Address - Fax:
Practice Address - Street 1:401 GRIST MILL CIR
Practice Address - Street 2:
Practice Address - City:ROSLYN
Practice Address - State:NY
Practice Address - Zip Code:11576-1639
Practice Address - Country:US
Practice Address - Phone:917-375-3883
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-20
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY864075133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered