Provider Demographics
NPI:1033452859
Name:ALDRIDGE, COLLEEN (RD)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:
Last Name:ALDRIDGE
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7521 STATE HIGHWAY 58
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:NY
Mailing Address - Zip Code:13646-4176
Mailing Address - Country:US
Mailing Address - Phone:315-578-2201
Mailing Address - Fax:
Practice Address - Street 1:732 FORD ST
Practice Address - Street 2:UNITED HELPERS MOSAIC INC
Practice Address - City:OGDENSBURG
Practice Address - State:NY
Practice Address - Zip Code:13669-1704
Practice Address - Country:US
Practice Address - Phone:315-393-3072
Practice Address - Fax:315-394-7320
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-29
Last Update Date:2013-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY711697133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered