Healthcare Provider Details

I. General information

NPI: 1578229589
Provider Name (Legal Business Name): KLASIK NUTRITION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2021
Last Update Date: 08/30/2023
Certification Date: 08/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1523 EDGE HILL RD
ABINGTON PA
19001-2609
US

IV. Provider business mailing address

1523 EDGE HILL RD
ABINGTON PA
19001-2609
US

V. Phone/Fax

Practice location:
  • Phone: 215-961-7045
  • Fax:
Mailing address:
  • Phone: 215-961-7045
  • Fax:

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 Code133VN1005X
TaxonomyRenal Nutrition Registered Dietitian
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name: JERRY FLEMING
Title or Position: CO-OWNER
Credential:
Phone: 215-961-7045