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General NPI Number Information
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NPI Number | 1952268070
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Entity Type | Organization
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Legal Business Name | GUT GLOW HEALTH DIETETICS AND NUTRITION PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 01/09/2026
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Last Update Date | 01/09/2026
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Provider Practice Location Address
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Address Line | 415 GRAND ST APT 506
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City | NEW YORK
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State | NY
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Zip | 10002-4760
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Country | US
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Telephone | 201-429-3964
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Fax |
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Provider Business Mailing Address
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Address Line | 415 GRAND ST APT 506
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City | NEW YORK
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State | NY
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Zip | 10002-4760
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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 | WYATT LUONG
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Credential | RD
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Telephone | 646-748-6619
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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 |
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License Number State |
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