1720599533 NPI number — ERIN ELISABETH GOODRICH RDN, CDE

Table of content: ERIN ELISABETH GOODRICH RDN, CDE (NPI 1720599533)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720599533 NPI number — ERIN ELISABETH GOODRICH RDN, CDE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GOODRICH
Provider First Name:
ERIN
Provider Middle Name:
ELISABETH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RDN, CDE
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WILBERT
Provider Other First Name:
ERIN
Provider Other Middle Name:
ELISABETH
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1720599533
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
300 WEST AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BROCKPORT
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14420-1118
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
585-637-3905
Provider Business Mailing Address Fax Number:
585-637-4990

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 WEST AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BROCKPORT
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14420-1118
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
585-637-3905
Provider Business Practice Location Address Fax Number:
585-637-4990
Provider Enumeration Date:
10/19/2017

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 133V00000X , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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