Provider Demographics
NPI:1164584371
Name:TOWN TOTAL NUTRITION, INC
Entity Type:Organization
Organization Name:TOWN TOTAL NUTRITION, INC
Other - Org Name:CRITICAL CARE NURSING STAFFING AGENCY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:NURSING SUPERVISOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:DITUSA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-852-2667
Mailing Address - Street 1:532 BROADHOLLOW RD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747-3672
Mailing Address - Country:US
Mailing Address - Phone:516-832-2667
Mailing Address - Fax:516-832-2687
Practice Address - Street 1:532 BROADHOLLOW RD
Practice Address - Street 2:SUITE 106
Practice Address - City:MELVILLE
Practice Address - State:NY
Practice Address - Zip Code:11747-3672
Practice Address - Country:US
Practice Address - Phone:516-832-2667
Practice Address - Fax:516-832-2687
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY9067L002251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01522976Medicaid