Provider Demographics
NPI:1114331766
Name:ORSZULAK, MATTHEW (RDN, LDN)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:ORSZULAK
Suffix:
Gender:M
Credentials:RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 ATWATER AVE
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01944-1287
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8 ATWATER AVE
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:MA
Practice Address - Zip Code:01944-1287
Practice Address - Country:US
Practice Address - Phone:978-526-8900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-11
Last Update Date:2014-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3439133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered