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General NPI Number Information
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NPI Number | 1750800926
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Entity Type | Organization
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Legal Business Name | NNY HEALTH & WELLNESS LLC
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Dates
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Enumeration Date | 09/19/2017
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Last Update Date | 09/19/2017
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Provider Practice Location Address
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Address Line | 21011 STORRS RD
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City | SACKETS HARBOR
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State | NY
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Zip | 13685-3172
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Country | US
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Telephone | 315-775-8379
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Fax |
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Provider Business Mailing Address
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Address Line | 21011 STORRS RD
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City | SACKETS HARBOR
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State | NY
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Zip | 13685-3172
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Country | US
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Telephone | 720-771-6691
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Fax |
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Authorized Official
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Title or Position | OWNER/DIETITIAN
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Name | SUSAN KIM
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Credential | RD
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Telephone | 315-775-8379
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 008768
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License Number State | NY
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