Healthcare Provider Details

I. General information

NPI: 1700473592
Provider Name (Legal Business Name): URBAN NUTRITION CONSULTANTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2020
Last Update Date: 12/28/2020
Certification Date: 12/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 W 106TH ST APT 3D
NEW YORK NY
10025-3835
US

IV. Provider business mailing address

65 W 106TH ST APT 3D
NEW YORK NY
10025-3835
US

V. Phone/Fax

Practice location:
  • Phone: 901-238-8466
  • Fax: 833-734-1635
Mailing address:
  • Phone: 901-238-8466
  • Fax: 833-734-1635

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name: MR. NICHOLAS E RUSH
Title or Position: OWNER
Credential: RDN, CDN
Phone: 901-238-8466