Healthcare Provider Details

I. General information

NPI: 1639760739
Provider Name (Legal Business Name): NUTRITION IN MOTION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2021
Last Update Date: 02/01/2021
Certification Date: 02/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 BUHL LN
EAST NORTHPORT NY
11731-5215
US

IV. Provider business mailing address

31 BUHL LN
EAST NORTHPORT NY
11731-5215
US

V. Phone/Fax

Practice location:
  • Phone: 516-330-6040
  • Fax: 516-548-5264
Mailing address:
  • Phone:
  • Fax: 516-548-5264

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code133VN1201X
TaxonomyObesity and Weight Management Nutrition Registered Dietitian
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code133VN1501X
TaxonomySports Dietetics Nutrition Registered Dietitian
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name: CRISTINA RIVERA
Title or Position: PRESIDENT, REGISTERED DIETITIAN
Credential:
Phone: 516-712-5475