MEDICARE: NUTRITHYME LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian

General Provider Information

NPI Number	:	1124819156
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NUTRITHYME LLC

Provider Business Mailing Address
First Line	:	3391 POPLAR ST
Second Line	:
City	:	OCEANSIDE
State	:	NY
Zip	:	11572-4518
Country	:	US
Telephone Number	:	917-502-2272
Fax Number	:

Provider Business Practice Location Address
First Line	:	3391 POPLAR ST
Second Line	:
City	:	OCEANSIDE
State	:	NY
Zip	:	11572-4518
Country	:	US
Telephone Number	:	917-502-2272
Fax Number	:

Authorized Official
Title or Position	:	REGISTERED DIETITIAN
Name	:	CAMILLE G ZELTMANN
Credential	:	RDN,CDN
Telephone Number	:	917-502-2272

Provider Enumeration Date	:	05/17/2025
Last Update Date	:	05/17/2025

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