NPIMap

Organization Active NPI

Cornerstone Nutrition, LLC

  • Registered Dietitian
  • Manchester, CT
National Provider Identifier
1679984488
Registry record updated Sep 2, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered DietitianTaxonomy code 133V00000X
License
03-696456 Issued in CT
Legal business name
CORNERSTONE NUTRITION, LLC
Practice address
595 Main St
Manchester, CT 06040-5160
Phone
(860) 559-5178
NPI assigned
May 14, 2014
Last updated
Sep 2, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 2, 2014

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

Authorized official

Name
Brendan Coburn, RDNPI 1720480965
Title
Owner, Registered Dietitian
Phone
(860) 559-5178

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Dietitian 133V00000X 03-696456 CT Primary

Addresses

Primary practice location

595 Main St
Manchester, CT 06040-5160

Mailing address

568 Foster St
South Windsor, CT 06074-2935
Phone (860) 559-5178

National Provider Directory

National Provider Directory

Locations

595 Main St
Manchester, CT 06040
Phone (860) 559-5178

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1400025600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1409616000000",
    "number": "1679984488",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "568 FOSTER ST",
            "city": "SOUTH WINDSOR",
            "state": "CT",
            "postal_code": "060742935",
            "telephone_number": "860-559-5178"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "595 MAIN ST",
            "city": "MANCHESTER",
            "state": "CT",
            "postal_code": "060405160",
            "telephone_number": "860-559-5178"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CORNERSTONE NUTRITION, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-05-14",
        "last_updated": "2014-09-02",
        "status": "A",
        "authorized_official_last_name": "COBURN",
        "authorized_official_first_name": "BRENDAN",
        "authorized_official_title_or_position": "OWNER, REGISTERED DIETITIAN",
        "authorized_official_telephone_number": "860-559-5178",
        "authorized_official_credential": "RD"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "CT",
            "license": "03-696456",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Manchester, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2014; 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.