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1487516563 NPI number — COLLABORATIVE NUTRITION THERAPY LLC

NPI Number: 1487516563
Health Care Provider/Practitioner: COLLABORATIVE NUTRITION THERAPY LLC

Information about “1487516563” NPI (COLLABORATIVE NUTRITION THERAPY LLC) exists in 1487516563 in HTML format HTML  |  1487516563 in plain Text format TXT  |  1487516563 in PDF (Portable Document Format) PDF  |  1487516563 in an XML format XML  formats.

NPI Number : 1487516563 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1487516563",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "COLLABORATIVE NUTRITION THERAPY LLC",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "2389 MAIN ST",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "GLASTONBURY",
    "MailingAddressStateName": "CT",
    "MailingAddressPostalCode": "06033-4617",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "860-292-0760",
    "MailingAddressFaxNumber": "860-345-6678",
    "FirstLinePracticeLocationAddress": "2389 MAIN ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "GLASTONBURY",
    "PracticeLocationAddressStateName": "CT",
    "PracticeLocationAddressPostalCode": "06033-4617",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "860-538-7277",
    "PracticeLocationAddressFaxNumber": "186-034-5667",
    "EnumerationDate": "11/26/2025",
    "LastUpdateDate": "01/12/2026",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "RILEY",
    "AuthorizedOfficialFirstName": "MONIKA",
    "AuthorizedOfficialMiddleName": "K",
    "AuthorizedOfficialTitle": "DIETITIAN/OWNER",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "RDN",
    "AuthorizedOfficialTelephoneNumber": "860-292-0760",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "133V00000X",
        "TaxonomyName": "Registered Dietitian",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": {
        "HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY  GROUP",
        "HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
      }
    }
  }
}
                
            

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