Provider Demographics
NPI:1053951095
Name:GOSCILO, ANGELA H (MS, RD, CDN)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:H
Last Name:GOSCILO
Suffix:
Gender:F
Credentials:MS, RD, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 DAVIS AVE
Mailing Address - Street 2:
Mailing Address - City:VALHALLA
Mailing Address - State:NY
Mailing Address - Zip Code:10595-2002
Mailing Address - Country:US
Mailing Address - Phone:914-589-7196
Mailing Address - Fax:
Practice Address - Street 1:18 ASHFORD AVE STE 3W
Practice Address - Street 2:
Practice Address - City:DOBBS FERRY
Practice Address - State:NY
Practice Address - Zip Code:10522-1824
Practice Address - Country:US
Practice Address - Phone:914-589-7196
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-07
Last Update Date:2020-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009110133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered