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General NPI Number Information
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NPI Number | 1093184640
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Entity Type | Organization
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Legal Business Name | MOHAWK VALLEY NUTRITIONAL SERVICES, PLLC
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Dates
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Enumeration Date | 09/24/2015
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Last Update Date | 01/26/2016
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Provider Practice Location Address
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Address Line | 2600 ONEIDA ST
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City | UTICA
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State | NY
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Zip | 13501-6311
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Country | US
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Telephone | 315-732-9368
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Fax |
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Provider Business Mailing Address
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Address Line | 2600 ONEIDA ST
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City | UTICA
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State | NY
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Zip | 13501-6311
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | PRIYA M MATHEW
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Credential |
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Telephone | 315-732-9368
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 0050941
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License Number State | NY
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