Organization
NUTRTIONAL HEALTH CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MARITA HOLL RD (REGISTERED DIETICIAN)
(203) 234-0396
Entity
Organization
Contact information
Practice address
100 BROADWAY, NORTH HAVEN, CT 06473-2365
(203) 234-0396
Mailing address
100 BROADWAY, NORTH HAVEN, CT 06473-2365
(203) 234-0396
(203) 234-0801
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
000020
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
270000020CT02
ANTHEM
CT
01
—
5499494
AETNA
CT
01
—
P817491
OXFORD
CT
Enumeration date
01/16/2009
Last updated
01/16/2009
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