Provider Demographics
NPI:1023722006
Name:ABBOTT, CONNOR (RD, RDN)
Entity type:Individual
Prefix:
First Name:CONNOR
Middle Name:
Last Name:ABBOTT
Suffix:
Gender:M
Credentials:RD, RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:93 LEWIS ST
Mailing Address - Street 2:
Mailing Address - City:LOCKPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14094-4633
Mailing Address - Country:US
Mailing Address - Phone:716-201-6284
Mailing Address - Fax:
Practice Address - Street 1:2 RICHMOND AVE
Practice Address - Street 2:
Practice Address - City:BATAVIA
Practice Address - State:NY
Practice Address - Zip Code:14020-1408
Practice Address - Country:US
Practice Address - Phone:585-201-5686
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-13
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered