Provider Demographics
NPI:1841513561
Name:LIGI, BRIAN C (RD, LDN)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:C
Last Name:LIGI
Suffix:
Gender:M
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:463 PLYMOUTH RD
Mailing Address - Street 2:
Mailing Address - City:GLENSIDE
Mailing Address - State:PA
Mailing Address - Zip Code:19038-2803
Mailing Address - Country:US
Mailing Address - Phone:215-896-6345
Mailing Address - Fax:
Practice Address - Street 1:463 PLYMOUTH RD
Practice Address - Street 2:
Practice Address - City:GLENSIDE
Practice Address - State:PA
Practice Address - Zip Code:19038-2803
Practice Address - Country:US
Practice Address - Phone:215-896-6345
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-09
Last Update Date:2010-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN003383133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered