Healthcare Provider Details

I. General information

NPI: 1295736478
Provider Name (Legal Business Name): LAURIE BURTON-GREGO MS, RD, CDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2005
Last Update Date: 01/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 NEW KARNER RD SUITE 1A
ALBANY NY
12205-3882
US

IV. Provider business mailing address

711 TROY SCHENECTADY RD STE 203
LATHAM NY
12110-2461
US

V. Phone/Fax

Practice location:
  • Phone: 518-452-1337
  • Fax: 518-724-6660
Mailing address:
  • Phone: 518-782-3700
  • Fax: 518-782-3799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number005085
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: