MEDICARE: KONTOSNUTRITION INC.

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	133VN1006X	Metabolic Nutrition Registered Dietitian	006916	NY

General Provider Information

NPI Number	:	1285058107
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KONTOSNUTRITION INC.

Provider Business Mailing Address
First Line	:	425 CENTRAL PARK W
Second Line	:	SUITE # 6E
City	:	NEW YORK
State	:	NY
Zip	:	10025-4381
Country	:	US
Telephone Number	:	212-865-0701
Fax Number	:	212-865-0788

Provider Business Practice Location Address
First Line	:	425 CENTRAL PARK W
Second Line	:	SUITE # 6E
City	:	NEW YORK
State	:	NY
Zip	:	10025-4381
Country	:	US
Telephone Number	:	212-865-0701
Fax Number	:	212-865-0788

Authorized Official
Title or Position	:	PRESIDENT
Name	:	SPYRIDON N. KONTOS
Credential	:	RD, CDE
Telephone Number	:	212-865-0701

Provider Enumeration Date	:	02/12/2014
Last Update Date	:	02/12/2014

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