Healthcare Provider Details

I. General information

NPI: 1619111911
Provider Name (Legal Business Name): NUTRITION CONCEPTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2009
Last Update Date: 04/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3685 SOUTHWESTERN BLVD
ORCHARD PARK NY
14127-1732
US

IV. Provider business mailing address

3685 SOUTHWESTERN BLVD
ORCHARD PARK NY
14127-1732
US

V. Phone/Fax

Practice location:
  • Phone: 716-662-2408
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number006688
License Number StateNY

VIII. Authorized Official

Name: CHRISTINE C REEB
Title or Position: REGISTERED DIETITIAN
Credential:
Phone: 716-662-2408