Organization
NORTHEAST DIETITIAN LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MALAYA MOUNT (OWNER)
(360) 888-9293
Entity
Organization
Contact information
Practice address
192 STODDARD AVE, NEWINGTON, CT 06111-1914
(360) 888-9293
Mailing address
192 STODDARD AVE, NEWINGTON, CT 06111-1914
(360) 888-9293
Taxonomy
Speciality
Code
Description
License number
State
133VN1006X
Metabolic Nutrition Registered Dietitian
Primary
—
—
Other
Enumeration date
06/01/2023
Last updated
06/01/2023
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