Healthcare Provider Details

I. General information

NPI: 1720421233
Provider Name (Legal Business Name): THERESA ANN ZANGERLE R.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: THERESA ANN ZANGERLE R.D

II. Dates (important events)

Enumeration Date: 04/15/2013
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

159 BARNEGAT RD FL 2
POUGHKEEPSIE NY
12601-5401
US

IV. Provider business mailing address

159 BARNEGAT RD FL 2
POUGHKEEPSIE NY
12601-5401
US

V. Phone/Fax

Practice location:
  • Phone: 845-452-9800
  • Fax: 845-452-7691
Mailing address:
  • Phone: 845-452-9800
  • Fax: 845-452-7691

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number007724-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: