Healthcare Provider Details

I. General information

NPI: 1255243077
Provider Name (Legal Business Name): INTEGRATIVE NUTRITION AND DIETETICS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2026
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

62 WOODSIDE AVE
WEST HARRISON NY
10604-2822
US

IV. Provider business mailing address

62 WOODSIDE AVE
WEST HARRISON NY
10604-2822
US

V. Phone/Fax

Practice location:
  • Phone: 914-610-0463
  • Fax:
Mailing address:
  • Phone: 914-610-0463
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1201X
TaxonomyObesity and Weight Management Nutrition Registered Dietitian
License Number
License Number State

VIII. Authorized Official

Name: JILL GULOTTA
Title or Position: OWNER
Credential: MS, RDN, CDN, LHMC
Phone: 914-610-0463