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General NPI Number Information
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NPI Number | 1689916934
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Entity Type | Organization
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Legal Business Name | DA-NUTRITION PLLC
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Dates
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Enumeration Date | 03/25/2013
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Last Update Date | 06/29/2018
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Provider Practice Location Address
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Address Line | 41-10 BROWNE STREET, STE L3
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City | FLUSHING
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State | NY
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Zip | 11355
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Country | US
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Telephone | 718-961-1496
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Fax | 718-961-1494
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Provider Business Mailing Address
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Address Line | 41-10 BROWNE STREET, STE L3
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City | FLUSHING
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State | NY
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Zip | 11355
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Country | US
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Telephone | 718-961-1496
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Fax | 718-961-1494
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Authorized Official
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Title or Position | OWNER/MANAGER
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Name | MISS IDA MAN SHAN LAM
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Credential |
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Telephone | 718-961-1496
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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