| Organization Name: | ANJALI P GUPTE .CERTIFIED DIETITIAN/CERTIFIED NUTRITONIST.LLC |
| NPI Number: | 1528324456 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | ANJALI PRADEEP GUPTE (SOLE PROPRIETER/OWNER) |
| Mailing Address: | 3 Larissa Ct Airmont |
| State: | NY US |
| Postal Code: | 109523833 |
| Phone Number: | 9149061285 |
| Fax Number: | 8454261109 |
| NPI Enumeration Date: | 04/04/2012 |
| NPI Last Update Date: | 04/05/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QC1800X |
| License Number: | 003372 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Corporate Health |
| Taxonomy Definition: | |