Provider Demographics
NPI:1235841560
Name:NOURISH BY ALY, LLC
Entity Type:Organization
Organization Name:NOURISH BY ALY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:ALYSON
Authorized Official - Middle Name:
Authorized Official - Last Name:COMEAU
Authorized Official - Suffix:
Authorized Official - Credentials:RDN, LDN
Authorized Official - Phone:978-895-6456
Mailing Address - Street 1:145 AMES ST UNIT 2113
Mailing Address - Street 2:
Mailing Address - City:MARLBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01752-4780
Mailing Address - Country:US
Mailing Address - Phone:978-895-6456
Mailing Address - Fax:
Practice Address - Street 1:145 AMES ST UNIT 2113
Practice Address - Street 2:
Practice Address - City:MARLBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01752-4780
Practice Address - Country:US
Practice Address - Phone:978-895-6456
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-19
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1245830272Medicaid