1043582026 NPI number — MS. LELLIETH KEIZE REGISTERED DIETITIAN

Table of content: MS. LELLIETH KEIZE REGISTERED DIETITIAN (NPI 1043582026)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043582026 NPI number — MS. LELLIETH KEIZE REGISTERED DIETITIAN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KEIZE
Provider First Name:
LELLIETH
Provider Middle Name:
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
REGISTERED DIETITIAN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LATCHMAN
Provider Other First Name:
LELLIETH
Provider Other Middle Name:
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MS, RDN, CDCES
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1043582026
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/15/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14 FERRIS AVE APT 10
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORWALK
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06854-1538
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-952-9715
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
19 OLD KINGS HWY S STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DARIEN
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06820-4532
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-952-3534
Provider Business Practice Location Address Fax Number:
203-803-4697
Provider Enumeration Date:
02/06/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 133V00000X , with the licence number:  965780 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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