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NPI Code Detail

MEDICARE: ANITA VELTA GRINEVICS RD

MEDICARE: ANITA VELTA GRINEVICS RD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1133V00000XRegistered Dietitian000639CT

General Provider Information

NPI Number : 1972872554
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANITA VELTA GRINEVICS RD
Provider Business Mailing Address
First Line : 136 BERLIN RD
Second Line :
City : CROMWELL
State : CT
Zip : 06416-2627
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 136 BERLIN RD
Second Line :
City : CROMWELL
State : CT
Zip : 06416-2627
Country : US
Telephone Number : 860-632-3977
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/28/2011
Last Update Date : 12/28/2011

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Directions to “ ANITA VELTA GRINEVICS RD” Practice Location

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