Provider Demographics
NPI:1245560317
Name:NATUROPATHIC FAMILY MEDICINE AND NUTRITION CENTER, LLC
Entity Type:Organization
Organization Name:NATUROPATHIC FAMILY MEDICINE AND NUTRITION CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NATALIE
Authorized Official - Middle Name:
Authorized Official - Last Name:COLICCI-FAVRETTO
Authorized Official - Suffix:
Authorized Official - Credentials:ND
Authorized Official - Phone:203-371-1021
Mailing Address - Street 1:2 CORPORATE DR STE 112
Mailing Address - Street 2:
Mailing Address - City:TRUMBULL
Mailing Address - State:CT
Mailing Address - Zip Code:06611-1376
Mailing Address - Country:US
Mailing Address - Phone:203-371-1021
Mailing Address - Fax:203-371-1022
Practice Address - Street 1:2 CORPORATE DR STE 112
Practice Address - Street 2:
Practice Address - City:TRUMBULL
Practice Address - State:CT
Practice Address - Zip Code:06611-1376
Practice Address - Country:US
Practice Address - Phone:203-371-1021
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-12
Last Update Date:2019-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000843133N00000X
CT000420175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Multi-Specialty
No133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1205062205OtherNPI