Organization
NATICK SPORTS AND RACQUET CLUB
Active
Other names
Longfellow Sports Club
Organization subpart
No
Provider details
NPI number
Authorized official
MISS JANE POLLEY M.S., R.D., LDN (DIETITIAN)
(508) 653-4633
Entity
Organization
Contact information
Practice address
203 OAK ST, LONGFELLOW SPORTS CLUB, NATICK, MA 01760-1306
(508) 653-4633
(508) 650-4986
Mailing address
203 OAK ST, LONGFELLOW SPORTS CLUB, NATICK, MA 01760-1306
(508) 653-4633
(508) 650-4986
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
LDN1011
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
39410
HARVARD PILGRIM HEALTH
MA
01
—
5582051
AETNA
MA
01
—
6300209
UNITED HEALTH CARE
MA
01
—
763282
TUFTS
MA
01
—
LD0022
BLUE CROSS BLUE SHIELD
MA
Enumeration date
11/19/2006
Last updated
08/22/2020
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