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General NPI Number Information
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NPI Number | 1528324456
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Entity Type | Organization
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Legal Business Name | ANJALI P GUPTE .CERTIFIED DIETITIAN/CERTIFIED NUTRITONIST.LLC
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Dates
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Enumeration Date | 04/04/2012
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Last Update Date | 04/05/2012
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Provider Practice Location Address
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Address Line | 3 LARISSA CT
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City | AIRMONT
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State | NY
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Zip | 10952-3833
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Country | US
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Telephone | 914-906-1285
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Fax | 845-426-1109
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Provider Business Mailing Address
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Address Line | 3 LARISSA CT
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City | AIRMONT
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State | NY
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Zip | 10952-3833
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Country | US
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Telephone | 914-906-1285
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Fax | 845-426-1109
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Authorized Official
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Title or Position | SOLE PROPRIETER/OWNER
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Name | MRS. ANJALI PRADEEP GUPTE
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Credential | R.D
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Telephone | 914-906-1285
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QC1800X
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Taxonomy Name | Corporate Health Clinic/Center
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License Number | 003372
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License Number State | NY
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