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General NPI Number Information
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NPI Number | 1689315335
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Entity Type | Organization
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Legal Business Name | CUSTOM FIT NUTRITION COUNSELING, LLC
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Dates
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Enumeration Date | 04/06/2022
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Last Update Date | 04/06/2022
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Provider Practice Location Address
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Address Line | 2732 LUCAS TPKE
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City | ACCORD
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State | NY
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Zip | 12404-5609
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Country | US
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Telephone | 914-584-9593
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Fax |
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Provider Business Mailing Address
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Address Line | 2732 LUCAS TPKE
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City | ACCORD
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State | NY
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Zip | 12404-5609
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Country | US
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Telephone | 914-584-9593
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JENNIFER MARIE BENDELIUS
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Credential | CDN
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Telephone | 914-584-9593
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133N00000X
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Taxonomy Name | Nutritionist
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License Number |
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License Number State |
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