Healthcare Provider Details

I. General information

NPI: 1164925095
Provider Name (Legal Business Name): EMILY LAURA JANUSESKI MPH, RD, CDN, CSO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/16/2018
Last Update Date: 11/21/2022
Certification Date: 11/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5008 BRITTONFIELD PKWY STE 700
EAST SYRACUSE NY
13057
US

IV. Provider business mailing address

5008 BRITTONFIELD PKWY STE 700
EAST SYRACUSE NY
13057-9249
US

V. Phone/Fax

Practice location:
  • Phone: 315-472-7504
  • Fax: 315-634-4677
Mailing address:
  • Phone: 315-472-7504
  • Fax: 315-634-4677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number008777
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: