MEDICARE: UNDERSTANDING EXERCISE, ACTIVITY AND THE RIGHT NUTRITION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QH0100X	Health Service Clinic/Center

General Provider Information

NPI Number	:	1235473216
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNDERSTANDING EXERCISE, ACTIVITY AND THE RIGHT NUTRITION

Provider Business Mailing Address
First Line	:	826 MERRICK RD
Second Line	:
City	:	BALDWIN
State	:	NY
Zip	:	11510-3354
Country	:	US
Telephone Number	:	516-442-4343
Fax Number	:

Provider Business Practice Location Address
First Line	:	826 MERRICK RD
Second Line	:
City	:	BALDWIN
State	:	NY
Zip	:	11510-3354
Country	:	US
Telephone Number	:	516-442-4343
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	KRISTIE LENGEL
Credential	:
Telephone Number	:	516-633-1001

Provider Enumeration Date	:	11/15/2012
Last Update Date	:	11/15/2012

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