Provider Demographics
NPI:1992911630
Name:PRINCE, JUDITH CHRISTINE (RD)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:CHRISTINE
Last Name:PRINCE
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:JUDITH
Other - Middle Name:CHRISTINE
Other - Last Name:PRINCE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RD
Mailing Address - Street 1:505 E 70TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-4872
Mailing Address - Country:US
Mailing Address - Phone:212-746-3149
Mailing Address - Fax:212-746-3177
Practice Address - Street 1:525 E 68TH ST
Practice Address - Street 2:GREENBERG PAVILION RM 10-171
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-4870
Practice Address - Country:US
Practice Address - Phone:212-746-0838
Practice Address - Fax:516-437-4167
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2008-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000873-1133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist