Healthcare Provider Details

I. General information

NPI: 1437144227
Provider Name (Legal Business Name): JUDITH CARR R.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/17/2005
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 LAWRENCE ST
SARATOGA SPRINGS NY
12866-1346
US

IV. Provider business mailing address

119 LAWRENCE ST
SARATOGA SPRINGS NY
12866-1346
US

V. Phone/Fax

Practice location:
  • Phone: 518-584-7361
  • Fax: 518-584-7930
Mailing address:
  • Phone: 518-584-7361
  • Fax: 518-584-7930

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number002198
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: