Provider Demographics
NPI:1619002532
Name:DLUGOKECKI, LESLIE ANN (RD)
Entity type:Individual
Prefix:MS
First Name:LESLIE
Middle Name:ANN
Last Name:DLUGOKECKI
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:NAUGATUCK
Mailing Address - State:CT
Mailing Address - Zip Code:06770-4180
Mailing Address - Country:US
Mailing Address - Phone:203-729-7818
Mailing Address - Fax:203-729-7818
Practice Address - Street 1:175 CHURCH ST
Practice Address - Street 2:
Practice Address - City:NAUGATUCK
Practice Address - State:CT
Practice Address - Zip Code:06770-4180
Practice Address - Country:US
Practice Address - Phone:203-525-9439
Practice Address - Fax:203-729-7818
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2011-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000022133VN1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT809245OtherDIETITIC REGISTRATION
CT710000008Medicare ID - Type UnspecifiedPROVIDER