Provider Demographics
NPI:1275598914
Name:OGRADY, JANET M (MS RD CDN CDE)
Entity Type:Individual
Prefix:MRS
First Name:JANET
Middle Name:M
Last Name:OGRADY
Suffix:
Gender:F
Credentials:MS RD CDN CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2340
Mailing Address - Street 2:
Mailing Address - City:SOUTHAMPTON
Mailing Address - State:NY
Mailing Address - Zip Code:11969-2340
Mailing Address - Country:US
Mailing Address - Phone:631-283-2100
Mailing Address - Fax:631-283-5731
Practice Address - Street 1:325 MEETING HOUSE LN
Practice Address - Street 2:BLDG #2 SUITE K
Practice Address - City:SOUTHAMPTON
Practice Address - State:NY
Practice Address - Zip Code:11968-5087
Practice Address - Country:US
Practice Address - Phone:631-283-2100
Practice Address - Fax:631-283-5731
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2008-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001749133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY9072E1Medicare ID - Type Unspecified