Basic Information
| Provider Information | |||||||||
| NPI: | 1710100698 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ROGALSKI | ||||||||
| FirstName: | MARY JANE | ||||||||
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| Credential: | RD, LDN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 32 WELLS PARK RD | ||||||||
| Address2: | |||||||||
| City: | STURBRIDGE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 015661316 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5083477650 | ||||||||
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| Practice Location | |||||||||
| Address1: | 759 CHESTNUT ST | ||||||||
| Address2: | BAYSTATE MEDICAL CENTER C1340 | ||||||||
| City: | SPRINGFIELD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 011991001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4137944954 | ||||||||
| FaxNumber: | 4137944949 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/10/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 507 | MA | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.