Provider Demographics
NPI:1366991952
Name:PRAGER, JUDY ELLEN (RDN, CDN)
Entity type:Individual
Prefix:
First Name:JUDY
Middle Name:ELLEN
Last Name:PRAGER
Suffix:
Gender:F
Credentials:RDN, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 CORNELL RD
Mailing Address - Street 2:
Mailing Address - City:NEW FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06812-3106
Mailing Address - Country:US
Mailing Address - Phone:203-512-7781
Mailing Address - Fax:
Practice Address - Street 1:19 CORNELL RD
Practice Address - Street 2:
Practice Address - City:NEW FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06812-3106
Practice Address - Country:US
Practice Address - Phone:203-512-7781
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-24
Last Update Date:2016-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000349133V00000X
RILDN00803133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered