Provider Demographics
NPI:1003446709
Name:MS NUTRITIONAL WELLNESS PLLC
Entity Type:Organization
Organization Name:MS NUTRITIONAL WELLNESS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:MAHTAB
Authorized Official - Middle Name:
Authorized Official - Last Name:SOLEIMANZADEH
Authorized Official - Suffix:
Authorized Official - Credentials:RD, CDN
Authorized Official - Phone:516-851-0401
Mailing Address - Street 1:1129 NORTHERN BLVD STE 404
Mailing Address - Street 2:
Mailing Address - City:MANHASSET
Mailing Address - State:NY
Mailing Address - Zip Code:11030-3022
Mailing Address - Country:US
Mailing Address - Phone:516-851-0401
Mailing Address - Fax:516-740-0285
Practice Address - Street 1:1129 NORTHERN BLVD STE 404
Practice Address - Street 2:
Practice Address - City:MANHASSET
Practice Address - State:NY
Practice Address - Zip Code:11030-3022
Practice Address - Country:US
Practice Address - Phone:516-851-0401
Practice Address - Fax:516-740-0285
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-22
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty