Provider Demographics
NPI:1174861413
Name:SIMPLY NUTRITION NYC
Entity Type:Organization
Organization Name:SIMPLY NUTRITION NYC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:KATRIN
Authorized Official - Middle Name:KA LO
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RD, CDN
Authorized Official - Phone:646-262-5445
Mailing Address - Street 1:22 N 6TH ST APT 20I
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11249-3091
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:211 E 43RD ST
Practice Address - Street 2:#2301
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-4707
Practice Address - Country:US
Practice Address - Phone:646-262-5445
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-22
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1034217133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty