Provider Demographics
NPI:1205178118
Name:PYRAMID NUTRITION SERVICES
Entity Type:Organization
Organization Name:PYRAMID NUTRITION SERVICES
Other - Org Name:NICOLE K FRANK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:KATHLEEN
Authorized Official - Last Name:FRANK-MASLAR
Authorized Official - Suffix:
Authorized Official - Credentials:RD, LDN
Authorized Official - Phone:413-427-6340
Mailing Address - Street 1:870 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01103-2105
Mailing Address - Country:US
Mailing Address - Phone:413-427-6340
Mailing Address - Fax:413-480-0517
Practice Address - Street 1:870 MAIN ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01103-2105
Practice Address - Country:US
Practice Address - Phone:413-427-6340
Practice Address - Fax:413-480-0517
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-19
Last Update Date:2013-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1705133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0024280Medicare PIN
MA003001201Medicare PIN