Provider Demographics
NPI:1235856402
Name:SUZANNE FULTZ NUTRITION, PLLC
Entity Type:Organization
Organization Name:SUZANNE FULTZ NUTRITION, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:GERDES
Authorized Official - Last Name:FULTZ
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RD, CSOWM, CDN
Authorized Official - Phone:845-729-1345
Mailing Address - Street 1:291 N LITTLE TOR RD
Mailing Address - Street 2:
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956-2205
Mailing Address - Country:US
Mailing Address - Phone:845-729-1345
Mailing Address - Fax:
Practice Address - Street 1:291 N LITTLE TOR RD
Practice Address - Street 2:
Practice Address - City:NEW CITY
Practice Address - State:NY
Practice Address - Zip Code:10956-2205
Practice Address - Country:US
Practice Address - Phone:845-729-1345
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-27
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
No133VN1201XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Obesity and Weight ManagementGroup - Single Specialty