MEDICARE: COMPASS NUTRITION 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	007095	NY

General Provider Information

NPI Number	:	1962823484
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMPASS NUTRITION LLC

Provider Business Mailing Address
First Line	:	90 BROAD ST FL 2
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10004-3313
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	22 CORTLANDT ST
Second Line	:	SUITE 1632
City	:	NEW YORK
State	:	NY
Zip	:	10007-3107
Country	:	US
Telephone Number	:	212-419-0399
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ADIANA CASTRO
Credential	:	MS, RD, CDN
Telephone Number	:	212-419-0399

Provider Enumeration Date	:	12/31/2013
Last Update Date	:	05/04/2023

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Directions to “COMPASS NUTRITION LLC ” Practice Location

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