Provider Demographics
NPI:1134702905
Name:NUTRITION SYNERGY, LLC
Entity Type:Organization
Organization Name:NUTRITION SYNERGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOCELYN
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RD, LDN
Authorized Official - Phone:978-561-6363
Mailing Address - Street 1:462 BOSTON ST STE 2-S1
Mailing Address - Street 2:
Mailing Address - City:TOPSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01983-1200
Mailing Address - Country:US
Mailing Address - Phone:978-561-6363
Mailing Address - Fax:
Practice Address - Street 1:462 BOSTON ST STE 2-S1
Practice Address - Street 2:
Practice Address - City:TOPSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01983-1200
Practice Address - Country:US
Practice Address - Phone:978-561-6363
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-29
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH1104OtherNH LICENSURE
MA1427568567OtherTYPE 1 NPI
MA4353OtherMA LICENSURE