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General NPI Number Information
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NPI Number | 1578229589
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Entity Type | Organization
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Legal Business Name | KLASIK NUTRITION
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Dates
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Enumeration Date | 11/14/2021
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Last Update Date | 08/30/2023
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Provider Practice Location Address
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Address Line | 1523 EDGE HILL RD
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City | ABINGTON
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State | PA
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Zip | 19001-2609
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Country | US
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Telephone | 215-961-7045
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Fax |
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Provider Business Mailing Address
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Address Line | 1523 EDGE HILL RD
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City | ABINGTON
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State | PA
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Zip | 19001-2609
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Country | US
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Telephone | 215-961-7045
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Fax |
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Authorized Official
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Title or Position | CO-OWNER
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Name | JERRY FLEMING
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Credential |
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Telephone | 215-961-7045
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133VN1004X
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Taxonomy Name | Pediatric 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 | 133VN1005X
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Taxonomy Name | Renal 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 | 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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