Provider Demographics
NPI:1073916110
Name:B.KOMPLETE, LLC
Entity Type:Organization
Organization Name:B.KOMPLETE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:BERYL
Authorized Official - Middle Name:F
Authorized Official - Last Name:KRINSKY
Authorized Official - Suffix:
Authorized Official - Credentials:MBA, MS, RDN
Authorized Official - Phone:215-764-9651
Mailing Address - Street 1:200 W WASHINGTON SQ
Mailing Address - Street 2:1002
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19106-3513
Mailing Address - Country:US
Mailing Address - Phone:215-764-9651
Mailing Address - Fax:
Practice Address - Street 1:200 W WASHINGTON SQ
Practice Address - Street 2:1002
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19106-3513
Practice Address - Country:US
Practice Address - Phone:215-764-9651
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-03
Last Update Date:2014-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN005313133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty