Provider Demographics
NPI:1538615380
Name:LIGI, PETERJASON (RDN, LDN)
Entity type:Individual
Prefix:MR
First Name:PETERJASON
Middle Name:
Last Name:LIGI
Suffix:
Gender:M
Credentials:RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 5TH ST
Mailing Address - Street 2:
Mailing Address - City:MAYFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:18433-1510
Mailing Address - Country:US
Mailing Address - Phone:570-267-6617
Mailing Address - Fax:
Practice Address - Street 1:122 5TH ST
Practice Address - Street 2:
Practice Address - City:MAYFIELD
Practice Address - State:PA
Practice Address - Zip Code:18433
Practice Address - Country:US
Practice Address - Phone:570-267-6617
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-31
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN005776133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered