Provider Demographics
NPI:1467036624
Name:NICOLE BARRATO DBA NUTRIGREENE
Entity Type:Organization
Organization Name:NICOLE BARRATO DBA NUTRIGREENE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:BARRATO
Authorized Official - Suffix:
Authorized Official - Credentials:RDN
Authorized Official - Phone:914-318-1462
Mailing Address - Street 1:86 TIDE MILL TER
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06824-5653
Mailing Address - Country:US
Mailing Address - Phone:914-318-1462
Mailing Address - Fax:203-816-6656
Practice Address - Street 1:544 RIVERSIDE AVE
Practice Address - Street 2:
Practice Address - City:WESTPORT
Practice Address - State:CT
Practice Address - Zip Code:06880-5731
Practice Address - Country:US
Practice Address - Phone:203-429-4211
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-12
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001100OtherCERTITIFIEC DIETITIAN NUTRITIONIST
CT001100OtherN/A