Provider Demographics
NPI:1053684415
Name:SOOLMAN NUTRITION LLC
Entity Type:Organization
Organization Name:SOOLMAN NUTRITION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN / CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JONAH
Authorized Official - Middle Name:
Authorized Official - Last Name:SOOLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:RD, LDN
Authorized Official - Phone:781-433-0470
Mailing Address - Street 1:36 BONWOOD RD
Mailing Address - Street 2:
Mailing Address - City:NEEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02492-1652
Mailing Address - Country:US
Mailing Address - Phone:781-433-0470
Mailing Address - Fax:781-433-0471
Practice Address - Street 1:36 BONWOOD RD
Practice Address - Street 2:
Practice Address - City:NEEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02492-1652
Practice Address - Country:US
Practice Address - Phone:781-433-0470
Practice Address - Fax:781-433-0471
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-15
Last Update Date:2018-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2760133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty