Healthcare Provider Details

I. General information

NPI: 1093304834
Provider Name (Legal Business Name): MATT J STRANBERG MS RDN LDN CSSD CSCS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/15/2021
Last Update Date: 01/15/2021
Certification Date: 01/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 ROSE GARDEN CIR
BOSTON MA
02135-4606
US

IV. Provider business mailing address

9 ROSE GARDEN CIR
BOSTON MA
02135-4606
US

V. Phone/Fax

Practice location:
  • Phone: 978-201-6607
  • Fax:
Mailing address:
  • Phone: 978-201-6607
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1501X
TaxonomySports Dietetics Nutrition Registered Dietitian
License Number86042761
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: