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General NPI Number Information
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NPI Number | 1780122838
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Entity Type | Organization
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Legal Business Name | NUTRITION CONCEPTS
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Dates
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Enumeration Date | 02/09/2017
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Last Update Date | 02/09/2017
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Provider Practice Location Address
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Address Line | 1212 SAXON AVE
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City | BAY SHORE
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State | NY
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Zip | 11706-5847
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Country | US
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Telephone | 631-671-3809
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Fax |
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Provider Business Mailing Address
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Address Line | 1212 SAXON AVE
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City | BAY SHORE
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State | NY
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Zip | 11706-5847
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Country | US
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Telephone |
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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. CRAIG IRBY
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Credential |
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Telephone | 631-968-0076
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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