Provider Demographics
NPI:1033492582
Name:HIS RHEMA NUTRITION SERVICES, LLC
Entity Type:Organization
Organization Name:HIS RHEMA NUTRITION SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:OYEWOLE
Authorized Official - Last Name:ADEYEYE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, MPH, RD, CDN
Authorized Official - Phone:718-569-5168
Mailing Address - Street 1:9050 PARSONS BLVD., SUITE 304
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432-6052
Mailing Address - Country:US
Mailing Address - Phone:718-569-5168
Mailing Address - Fax:718-569-5164
Practice Address - Street 1:9050 PARSONS BLVD STE 304
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-6052
Practice Address - Country:US
Practice Address - Phone:718-569-5168
Practice Address - Fax:718-569-5164
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-21
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005445133VN1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, MetabolicGroup - Single Specialty