Basic Information
| Provider Information | |||||||||
| NPI: | 1609008028 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PATEL | ||||||||
| FirstName: | SUJATA | ||||||||
| MiddleName: | |||||||||
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| Credential: | RD, CDN, CCN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 250 MERCER STREET | ||||||||
| Address2: | SUIT B 308 | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10012 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2038633617 | ||||||||
| FaxNumber: | 2038634538 | ||||||||
| Practice Location | |||||||||
| Address1: | 35 RIVER RD | ||||||||
| Address2: | CENTER FOR INTEGRATIVE MEDICIN | ||||||||
| City: | COS COB | ||||||||
| State: | CT | ||||||||
| PostalCode: | 068072759 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2038633615 | ||||||||
| FaxNumber: | 2038634538 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/18/2009 | ||||||||
| LastUpdateDate: | 05/06/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | 000852 | CT | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
ID Information
| ID | Type | State | Issuer | Description | 000852 | 01 | CT | DEPARTMENT OF PUBLIC HEALTH | OTHER |