Provider Demographics
NPI:1962769083
Name:HUSZAGH, VIRGINIA A (RD)
Entity type:Individual
Prefix:MS
First Name:VIRGINIA
Middle Name:A
Last Name:HUSZAGH
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 WARREN RD,
Mailing Address - Street 2:APT 22-1F
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-1236
Mailing Address - Country:US
Mailing Address - Phone:607-738-1815
Mailing Address - Fax:
Practice Address - Street 1:700 WARREN RD,
Practice Address - Street 2:APT 22-1F
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-1236
Practice Address - Country:US
Practice Address - Phone:607-738-1815
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-13
Last Update Date:2012-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000282-1133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered