Organization
ROOT DEEP NUTRITION AND WELLNESS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANNE MARIE BERGGREN RDN (OWNER)
(631) 560-4466
Entity
Organization
Contact information
Practice address
646 MAIN ST, PORT JEFFERSON, NY 11777-2235
(631) 560-4466
Mailing address
22 CLEMATIS ST, PORT JEFFERSON STATION, NY 11776-1802
(163) 156-0446
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
—
—
Other
Enumeration date
02/15/2024
Last updated
02/15/2024
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