Eat Well Live Well Inc

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

000673 Issued in NY

Legal business name

EAT WELL LIVE WELL INC

Practice address

200 E Main St
Patchogue, NY 11772-3159

Phone

(631) 689-6528

Fax

(631) 689-3074

NPI assigned

Feb 18, 2010

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Girija S Ayyala, MS, RD, CDN

Title

Owner

Phone

(631) 689-6528

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1266451200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1266451200000",
    "number": "1376865360",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22 HILLSIDE RD",
            "city": "STONY BROOK",
            "state": "NY",
            "postal_code": "117901019",
            "telephone_number": "631-689-6528",
            "fax_number": "631-689-3074"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 E MAIN ST",
            "city": "PATCHOGUE",
            "state": "NY",
            "postal_code": "117723159",
            "telephone_number": "631-689-6528",
            "fax_number": "631-689-3074"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAT WELL LIVE WELL INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-02-18",
        "last_updated": "2010-02-18",
        "status": "A",
        "authorized_official_last_name": "AYYALA",
        "authorized_official_first_name": "GIRIJA",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "631-689-6528",
        "authorized_official_credential": "MS, RD, CDN"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dietitian, Registered",
            "state": "NY",
            "license": "000673",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Registered Dietitian in Patchogue, NY
• Providers in Patchogue, NY by specialty
• Registered Dietitian in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 18, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.