Provider Demographics
NPI:1710218383
Name:PUIG, PAOLA ANDREA (MPH, RD, CDE, CD-N)
Entity Type:Individual
Prefix:MRS
First Name:PAOLA
Middle Name:ANDREA
Last Name:PUIG
Suffix:
Gender:F
Credentials:MPH, RD, CDE, CD-N
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 W RAYMOND AVE
Mailing Address - Street 2:
Mailing Address - City:ROOSEVELT
Mailing Address - State:NY
Mailing Address - Zip Code:11575-1042
Mailing Address - Country:US
Mailing Address - Phone:516-771-0076
Mailing Address - Fax:516-771-0076
Practice Address - Street 1:75 W RAYMOND AVE
Practice Address - Street 2:
Practice Address - City:ROOSEVELT
Practice Address - State:NY
Practice Address - Zip Code:11575-1042
Practice Address - Country:US
Practice Address - Phone:516-771-0076
Practice Address - Fax:516-771-0076
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-21
Last Update Date:2010-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY836157133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered