Provider Demographics
NPI:1295736478
Name:BURTON-GREGO, LAURIE (MS, RD, CDN)
Entity type:Individual
Prefix:MRS
First Name:LAURIE
Middle Name:
Last Name:BURTON-GREGO
Suffix:
Gender:F
Credentials:MS, RD, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 TROY SCHENECTADY RD STE 203
Mailing Address - Street 2:
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-2461
Mailing Address - Country:US
Mailing Address - Phone:518-782-3700
Mailing Address - Fax:518-782-3799
Practice Address - Street 1:501 NEW KARNER RD
Practice Address - Street 2:SUITE 1A
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12205-3882
Practice Address - Country:US
Practice Address - Phone:518-452-1337
Practice Address - Fax:518-724-6660
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2018-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005085133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY7436613OtherAETNA
NY161DE1OtherEMPIRE BLUECROSS
NY03273609Medicaid
NY161DE1OtherEMPIRE BLUECROSS
NY03273609Medicaid