Provider Demographics
NPI:1245511773
Name:RICHARD SANTUCCI, RD, CDN, PLLC
Entity type:Organization
Organization Name:RICHARD SANTUCCI, RD, CDN, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN, OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:SANTUCCI
Authorized Official - Suffix:
Authorized Official - Credentials:RD, CDN
Authorized Official - Phone:716-997-4583
Mailing Address - Street 1:25 WANSFELL RD
Mailing Address - Street 2:
Mailing Address - City:SNYDER
Mailing Address - State:NY
Mailing Address - Zip Code:14226-4631
Mailing Address - Country:US
Mailing Address - Phone:716-997-4583
Mailing Address - Fax:716-839-6585
Practice Address - Street 1:4511 MAIN ST
Practice Address - Street 2:SNYDER HOLISTIC
Practice Address - City:SNYDER
Practice Address - State:NY
Practice Address - Zip Code:14226-3809
Practice Address - Country:US
Practice Address - Phone:716-997-4583
Practice Address - Fax:716-839-6585
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-29
Last Update Date:2011-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty