Provider Demographics
NPI:1700150430
Name:COLE, GAIL RUTH (MS, RD, CDN)
Entity Type:Individual
Prefix:
First Name:GAIL
Middle Name:RUTH
Last Name:COLE
Suffix:
Gender:F
Credentials:MS, RD, CDN
Other - Prefix:
Other - First Name:GAIL
Other - Middle Name:
Other - Last Name:WIKLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, RD, CDN
Mailing Address - Street 1:165 WHITFIELD ST
Mailing Address - Street 2:FIRST FLOOR
Mailing Address - City:GUILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06437-3431
Mailing Address - Country:US
Mailing Address - Phone:914-629-5712
Mailing Address - Fax:
Practice Address - Street 1:165 WHITFIELD ST
Practice Address - Street 2:FIRST FLOOR
Practice Address - City:GUILFORD
Practice Address - State:CT
Practice Address - Zip Code:06437-3431
Practice Address - Country:US
Practice Address - Phone:914-629-5712
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-27
Last Update Date:2013-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
970909133V00000X
CT001095133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered