Provider Demographics
NPI:1073078531
Name:BODY DYNAMICS NUTRITION
Entity Type:Organization
Organization Name:BODY DYNAMICS NUTRITION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:SZEBENI
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RD, LD/N
Authorized Official - Phone:305-924-7319
Mailing Address - Street 1:10 BROOK LN
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:MA
Mailing Address - Zip Code:01503-1672
Mailing Address - Country:US
Mailing Address - Phone:305-924-7319
Mailing Address - Fax:
Practice Address - Street 1:11 APEX DR
Practice Address - Street 2:
Practice Address - City:MARLBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01752-1858
Practice Address - Country:US
Practice Address - Phone:305-924-7319
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-08
Last Update Date:2019-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, MetabolicGroup - Single Specialty
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth ServiceGroup - Single Specialty