Provider Demographics
NPI:1528324456
Name:ANJALI P GUPTE .CERTIFIED DIETITIAN/CERTIFIED NUTRITONIST.LLC
Entity type:Organization
Organization Name:ANJALI P GUPTE .CERTIFIED DIETITIAN/CERTIFIED NUTRITONIST.LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETER/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANJALI
Authorized Official - Middle Name:PRADEEP
Authorized Official - Last Name:GUPTE
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:914-906-1285
Mailing Address - Street 1:3 LARISSA CT
Mailing Address - Street 2:
Mailing Address - City:AIRMONT
Mailing Address - State:NY
Mailing Address - Zip Code:10952-3833
Mailing Address - Country:US
Mailing Address - Phone:914-906-1285
Mailing Address - Fax:845-426-1109
Practice Address - Street 1:3 LARISSA CT
Practice Address - Street 2:
Practice Address - City:AIRMONT
Practice Address - State:NY
Practice Address - Zip Code:10952-3833
Practice Address - Country:US
Practice Address - Phone:914-906-1285
Practice Address - Fax:845-426-1109
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-04
Last Update Date:2012-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003372261QC1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1800XAmbulatory Health Care FacilitiesClinic/CenterCorporate Health