Provider Demographics
NPI:1578840450
Name:BLUE CIRCLE DIETETICS & NUTRITION PC
Entity Type:Organization
Organization Name:BLUE CIRCLE DIETETICS & NUTRITION PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:C
Authorized Official - Last Name:ENSMINGER
Authorized Official - Suffix:
Authorized Official - Credentials:RD, CDE
Authorized Official - Phone:716-908-9434
Mailing Address - Street 1:PO BOX 4876
Mailing Address - Street 2:
Mailing Address - City:GREENWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06831-0417
Mailing Address - Country:US
Mailing Address - Phone:203-612-3430
Mailing Address - Fax:
Practice Address - Street 1:574 MAIN ST
Practice Address - Street 2:SUITE 203
Practice Address - City:EAST AURORA
Practice Address - State:NY
Practice Address - Zip Code:14052-1751
Practice Address - Country:US
Practice Address - Phone:716-908-9434
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-07
Last Update Date:2012-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty