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General NPI Number Information
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NPI Number | 1558958009
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Entity Type | Organization
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Legal Business Name | GEORGETOWN FITNESS INC
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Dates
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Enumeration Date | 12/30/2020
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Last Update Date | 01/25/2021
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Provider Practice Location Address
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Address Line | 5225 SHERIDAN DR
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City | WILLIAMSVILLE
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State | NY
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Zip | 14221-3573
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Country | US
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Telephone | 716-580-3362
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Fax |
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Provider Business Mailing Address
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Address Line | 5225 SHERIDAN DR
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City | WILLIAMSVILLE
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State | NY
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Zip | 14221-3573
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Country | US
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Telephone | 607-280-3441
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. DAVID JACOBS JR.
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Credential |
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Telephone | 607-280-3441
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133VN1006X
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Taxonomy Name | Metabolic Nutrition Registered Dietitian
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 133VN1201X
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Taxonomy Name | Obesity and Weight Management Nutrition Registered Dietitian
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 133VN1301X
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Taxonomy Name | Oncology Nutrition Registered Dietitian
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 133VN1501X
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Taxonomy Name | Sports Dietetics Nutrition Registered Dietitian
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number |
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License Number State |
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