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General NPI Number Information
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NPI Number | 1164584371
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Entity Type | Organization
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Legal Business Name | TOWN TOTAL NUTRITION, INC
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Dates
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Enumeration Date | 12/14/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 532 BROADHOLLOW RD SUITE 106
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City | MELVILLE
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State | NY
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Zip | 11747-3672
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Country | US
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Telephone | 516-832-2667
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Fax | 516-832-2687
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Provider Business Mailing Address
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Address Line | 532 BROADHOLLOW RD SUITE 106
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City | MELVILLE
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State | NY
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Zip | 11747-3672
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Country | US
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Telephone | 516-832-2667
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Fax | 516-832-2687
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Authorized Official
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Title or Position | NURSING SUPERVISOR
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Name | MR. MICHAEL DITUSA
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Credential |
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Telephone | 516-852-2667
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number | 9067L002
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License Number State | NY
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