Healthcare Provider Details

I. General information

NPI: 1275598914
Provider Name (Legal Business Name): JANET M OGRADY MS RD CDN CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2006
Last Update Date: 04/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 MEETING HOUSE LN BLDG #2 SUITE K
SOUTHAMPTON NY
11968-5087
US

IV. Provider business mailing address

PO BOX 2340
SOUTHAMPTON NY
11969-2340
US

V. Phone/Fax

Practice location:
  • Phone: 631-283-2100
  • Fax: 631-283-5731
Mailing address:
  • Phone: 631-283-2100
  • Fax: 631-283-5731

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number001749
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: