Healthcare Provider Details

I. General information

NPI: 1487343844
Provider Name (Legal Business Name): STEP NUTRITION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2023
Last Update Date: 05/09/2024
Certification Date: 05/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7393 TAFT PARK DR
EAST SYRACUSE NY
13057-9639
US

IV. Provider business mailing address

PO BOX 15256
SYRACUSE NY
13215-0256
US

V. Phone/Fax

Practice location:
  • Phone: 315-345-1363
  • Fax:
Mailing address:
  • Phone: 315-345-1363
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number StateNULL

VIII. Authorized Official

Name: GREGORY M BELZAK
Title or Position: OWNER
Credential: RD
Phone: 315-345-1363