Provider Demographics
NPI:1437687100
Name:LONERGAN, LINDA
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:LONERGAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 CORTLANDT MANOR RD
Mailing Address - Street 2:
Mailing Address - City:KATONAH
Mailing Address - State:NY
Mailing Address - Zip Code:10536-3203
Mailing Address - Country:US
Mailing Address - Phone:914-522-0729
Mailing Address - Fax:
Practice Address - Street 1:3505 HILL BLVD STE K
Practice Address - Street 2:
Practice Address - City:YORKTOWN HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:10598-1210
Practice Address - Country:US
Practice Address - Phone:914-522-0729
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-25
Last Update Date:2017-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
No133N00000XDietary & Nutritional Service ProvidersNutritionist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AHY-866934001OtherALLIED HEALTH PROFESSIONAL LIABILITY