=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639667538
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DEBORAH K OROSZ R.D.-N.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/25/2018
-----------------------------------------------------
Last Update Date | 08/10/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2 TUNXIS RD STE 203
-----------------------------------------------------
City | TARIFFVILLE
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06081
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-371-5881
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11 NUTMEG LN
-----------------------------------------------------
City | BLOOMFIELD
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06002-1611
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-371-5881
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 133VN1006X
-----------------------------------------------------
Taxonomy Name | Metabolic Nutrition Registered Dietitian
-----------------------------------------------------
License Number | 1647
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 133N00000X
-----------------------------------------------------
Taxonomy Name | Nutritionist
-----------------------------------------------------
License Number | 1647
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------