Healthcare Provider Details

I. General information

NPI: 1083068571
Provider Name (Legal Business Name): LAUREN ZANIKOS RD LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2016
Last Update Date: 12/18/2019
Certification Date: 12/18/2019
Deactivation Date: 02/03/2017
Reactivation Date: 12/17/2019

III. Provider practice location address

BODYMETRIX HEALTH AND WELLNESS SERVICES 403 W. RIDGE PIKE
LIMERICK PA
19468
US

IV. Provider business mailing address

1118 ASTOR ST.
NORRISTOWN PA
19401
US

V. Phone/Fax

Practice location:
  • Phone: 610-454-7332
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDN005847
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: