Provider Demographics
NPI:1316616543
Name:CENTER FOR PROGRESSIVE NUTRITION
Entity type:Organization
Organization Name:CENTER FOR PROGRESSIVE NUTRITION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARJORIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LIVINGSTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-653-8889
Mailing Address - Street 1:2 GREENWICH OFFICE PARK STE 300
Mailing Address - Street 2:
Mailing Address - City:GREENWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06831-5155
Mailing Address - Country:US
Mailing Address - Phone:203-653-8889
Mailing Address - Fax:
Practice Address - Street 1:2 GREENWICH OFFICE PARK STE 300
Practice Address - Street 2:
Practice Address - City:GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06831-5155
Practice Address - Country:US
Practice Address - Phone:203-653-8889
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-10
Last Update Date:2021-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001382OtherSTATE OF CONNECTICUT