Active NPI
Monique S Boulet, RD
- Registered Dietitian
- Lake George, NY
National Provider Identifier
1649463753
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 844475
- Practice address
- 23 Trinity Rock Rd
Lake George, NY 12845-6603 - Phone
- (518) 312-6309
- NPI assigned
- Aug 22, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 844475 | NY | Primary |
Addresses
Primary practice location
23 Trinity Rock Rd
Lake George, NY 12845-6603
Mailing address
23 Trinity Rock Rd
Lake George, NY 12845-6603
Phone (518) 312-6309
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NY
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20250124001767 | NY | Practitioner - Registered Dietitian Or Nutrition Professional | 5496284176 | Practice locations: Lake George, NY; Saratoga Springs, NY |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 844475 | NY | MD | Registered Dietitian |
| 005101 | NY | MD | Optician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1187740800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1721692800000",
"number": "1649463753",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "23 TRINITY ROCK RD",
"city": "LAKE GEORGE",
"state": "NY",
"postal_code": "128456603",
"telephone_number": "518-312-6309"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "23 TRINITY ROCK RD",
"city": "LAKE GEORGE",
"state": "NY",
"postal_code": "128456603",
"telephone_number": "518-312-6309"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOULET",
"first_name": "MONIQUE",
"middle_name": "S",
"name_prefix": "Ms.",
"credential": "RD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-08-22",
"last_updated": "2024-07-23",
"certification_date": "2024-07-23",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "NY",
"license": "844475",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lake George, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.