Healthcare Provider Details

I. General information

NPI: 1184174625
Provider Name (Legal Business Name): KELLY OGDEN M.S., R.D., C.D.N
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2016
Last Update Date: 10/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 WASHINGTON AVENUE EXT 101
ALBANY NY
12203-6326
US

IV. Provider business mailing address

11 E GLENWOOD DR
LATHAM NY
12110-3321
US

V. Phone/Fax

Practice location:
  • Phone: 518-218-1188
  • Fax:
Mailing address:
  • Phone: 518-421-9852
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number008642
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: