Provider Demographics
NPI:1548716475
Name:JUDY PRAGER
Entity type:Organization
Organization Name:JUDY PRAGER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN NUTRITIONIST
Authorized Official - Prefix:
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:E
Authorized Official - Last Name:PRAGER
Authorized Official - Suffix:
Authorized Official - Credentials:RDN
Authorized Official - Phone:203-512-7781
Mailing Address - Street 1:19 CORNELL RD
Mailing Address - Street 2:
Mailing Address - City:NEW FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06812-3106
Mailing Address - Country:US
Mailing Address - Phone:203-512-7781
Mailing Address - Fax:
Practice Address - Street 1:19 CORNELL RD
Practice Address - Street 2:
Practice Address - City:NEW FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06812-3106
Practice Address - Country:US
Practice Address - Phone:203-512-7781
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-31
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT03-346309133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty