Provider Demographics
NPI:1194180398
Name:CENTERPORT FITNESS & NUTRITION CORP
Entity Type:Organization
Organization Name:CENTERPORT FITNESS & NUTRITION CORP
Other - Org Name:FOREVER FIT HEALTH CLUB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:STRATTON
Authorized Official - Suffix:
Authorized Official - Credentials:RD, CDN, CSSD
Authorized Official - Phone:631-271-7820
Mailing Address - Street 1:96 WASHINGTON DR
Mailing Address - Street 2:
Mailing Address - City:CENTERPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11721-1817
Mailing Address - Country:US
Mailing Address - Phone:631-271-7820
Mailing Address - Fax:
Practice Address - Street 1:96 WASHINGTON DR
Practice Address - Street 2:
Practice Address - City:CENTERPORT
Practice Address - State:NY
Practice Address - Zip Code:11721-1817
Practice Address - Country:US
Practice Address - Phone:631-271-7820
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-15
Last Update Date:2015-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002532133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty