Provider Demographics
NPI:1083987473
Name:EATING FOR LIFE NUTRITION COUNSELING SERVICES, LLC
Entity Type:Organization
Organization Name:EATING FOR LIFE NUTRITION COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:HAZEWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:RD, LDN
Authorized Official - Phone:215-704-0767
Mailing Address - Street 1:735 ASHBOURNE RD
Mailing Address - Street 2:
Mailing Address - City:CHELTENHAM
Mailing Address - State:PA
Mailing Address - Zip Code:19012-1103
Mailing Address - Country:US
Mailing Address - Phone:215-704-0767
Mailing Address - Fax:
Practice Address - Street 1:735 ASHBOURNE RD
Practice Address - Street 2:
Practice Address - City:CHELTENHAM
Practice Address - State:PA
Practice Address - Zip Code:19012-1103
Practice Address - Country:US
Practice Address - Phone:215-704-0767
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-15
Last Update Date:2012-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN003889133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty