Elizabeth Joslow Archambault, REGISTERED DIETITIAN

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

851471 Issued in CT

Practice address

400 Saybrook Rd
Shoreline Surgical Associates Suite 110
Middletown, CT 06457

Phone

(860) 347-9167

Fax

(860) 347-1630

NPI assigned

Apr 17, 2007

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Elizabeth Ann Joslow Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1176768000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1437375920",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2 OLD COUNTY RD",
            "city": "CHESTER",
            "state": "CT",
            "postal_code": "06412",
            "telephone_number": "860-526-3250",
            "fax_number": "860-526-2412"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 SAYBROOK RD",
            "address_2": "SHORELINE SURGICAL ASSOCIATES SUITE 110",
            "city": "MIDDLETOWN",
            "state": "CT",
            "postal_code": "06457",
            "telephone_number": "860-347-9167",
            "fax_number": "860-347-1630"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ARCHAMBAULT",
        "first_name": "ELIZABETH",
        "middle_name": "JOSLOW",
        "name_prefix": "Ms.",
        "credential": "REGISTERED DIETITIAN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-04-17",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "CT",
            "license": "851471",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ELIZABETH",
            "last_name": "JOSLOW",
            "middle_name": "ANN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Registered Dietitian in Middletown, CT
• Providers in Middletown, CT by specialty
• Registered Dietitian in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.