Basic Information
| Provider Information | |||||||||
| NPI: | 1902002983 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NUTRITION IMPROVEMENT CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 978 RTE. 45 NORTHSIDE PLAZA | ||||||||
| Address2: | SUITE 107 | ||||||||
| City: | POMONA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10970 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8453621300 | ||||||||
| FaxNumber: | 8453621308 | ||||||||
| Practice Location | |||||||||
| Address1: | 978 RTE. 45 NORTHSIDE PLAZA | ||||||||
| Address2: | SUITE 107 | ||||||||
| City: | POMONA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10970 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8453621300 | ||||||||
| FaxNumber: | 8453621308 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/26/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | EPSTEIN | ||||||||
| AuthorizedOfficialFirstName: | IRIS | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8453621300 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | 003101-1 | NY | Y | 193400000X SINGLE SPECIALTY GROUP | Dietary & Nutritional Service Providers | Dietitian, Registered |
ID Information
| ID | Type | State | Issuer | Description | 9859218002 | 01 | NY | CIGNA | OTHER | 7248335 | 01 | NY | AETNA | OTHER | 8099864 | 01 | NY | GHI | OTHER | P2524572 | 01 | NY | OXFORD | OTHER | 2184571 | 01 | NY | UNITED | OTHER |