Healthcare Provider Details

I. General information

NPI: 1619002532
Provider Name (Legal Business Name): LESLIE ANN DLUGOKECKI R.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 03/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 CHURCH ST
NAUGATUCK CT
06770-4180
US

IV. Provider business mailing address

175 CHURCH ST
NAUGATUCK CT
06770-4180
US

V. Phone/Fax

Practice location:
  • Phone: 203-525-9439
  • Fax: 203-729-7818
Mailing address:
  • Phone: 203-729-7818
  • Fax: 203-729-7818

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License Number000022
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: