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Individual

MS. MARYANN GORMAN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
RD

Contact information

Practice address
98120 QUEENS BLVD, REGO PARK, NY 11374-4357
(718) 268-9598
(516) 488-3749
Mailing address
202 CHERRY LN, FLORAL PARK, NY 11001-1300
(781) 268-9598
(516) 488-3749

Taxonomy

Speciality
Code
Description
License number
State
133N00000X
Nutritionist
Primary
003481
NY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
164460
ELDERPLAN
NY
01
P2706184
OXFORD
NY
Enumeration date
11/23/2005
Last updated
01/27/2010
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