Provider Demographics
NPI:1114128238
Name:NUTRITIOM FIRST
Entity Type:Organization
Organization Name:NUTRITIOM FIRST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN, DIABETES ED
Authorized Official - Prefix:MRS
Authorized Official - First Name:LUANNE
Authorized Official - Middle Name:WRIGHT
Authorized Official - Last Name:PETRIE
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RD, CDE
Authorized Official - Phone:908-692-4140
Mailing Address - Street 1:29 EAST LARCHMONT DR
Mailing Address - Street 2:
Mailing Address - City:COLTS NECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07722
Mailing Address - Country:US
Mailing Address - Phone:908-692-4140
Mailing Address - Fax:
Practice Address - Street 1:29 E LARCHMONT DR
Practice Address - Street 2:
Practice Address - City:COLTS NECK
Practice Address - State:NJ
Practice Address - Zip Code:07722-1181
Practice Address - Country:US
Practice Address - Phone:908-692-4140
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY610878133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, EducationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJQ00595Medicare UPIN