Provider Demographics
NPI:1043439425
Name:NUTRIFOCUS PA
Entity Type:Organization
Organization Name:NUTRIFOCUS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:RINI
Authorized Official - Middle Name:
Authorized Official - Last Name:BANERJI
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:561-315-8538
Mailing Address - Street 1:PO BOX 31538
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33420-1538
Mailing Address - Country:US
Mailing Address - Phone:561-329-8683
Mailing Address - Fax:
Practice Address - Street 1:343 KINGFISHER DR
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-8351
Practice Address - Country:US
Practice Address - Phone:561-315-8538
Practice Address - Fax:561-625-8907
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND 1700133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty