Provider Demographics
NPI:1457334229
Name:BIGAOUETTE, JEAN MARGARET (MA,RD, CDE)
Entity Type:Individual
Prefix:MS
First Name:JEAN
Middle Name:MARGARET
Last Name:BIGAOUETTE
Suffix:
Gender:F
Credentials:MA,RD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:460 KRUMKILL RD
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12203-5948
Mailing Address - Country:US
Mailing Address - Phone:518-482-8704
Mailing Address - Fax:518-482-7672
Practice Address - Street 1:460 KRUMKILL RD
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12203-5948
Practice Address - Country:US
Practice Address - Phone:518-482-8704
Practice Address - Fax:518-482-7672
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-24
Last Update Date:2011-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000577-1133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY004904401OtherAPA PARTNERS
NY10000163OtherCDPHP
NYS0002OtherEMPIRE BLUE CROSS
NY000000018616OtherGHI
NY004904401OtherBSNENY
TN141621099 0000OtherCIGNA
NY990278OtherMVP
NY116366OtherWELLCARE
NYDD0751Medicare ID - Type Unspecified