Organization
THRIVE NUTRITION OF CT, LLC
Active
Parent organization
199 OFFICE SPACE, LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
199 OFFICE SPACE, LLC
Authorized official
MS. RENA A BRUCKMAN MS, RD (NUTRITIONIST)
(914) 320-3197
Entity
Organization
Contact information
Practice address
199 ETHAN ALLEN HWY, RIDGEFIELD, CT 06877-6212
(914) 320-3197
Mailing address
199 ETHAN ALLEN HWY, RIDGEFIELD, CT 06877-6212
(914) 320-3197
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
001294
CT
Other
Enumeration date
03/14/2016
Last updated
03/14/2016
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