Provider Demographics
NPI:1326791609
Name:CC NUTRITION & FITNESS INC
Entity Type:Organization
Organization Name:CC NUTRITION & FITNESS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:COEN
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:516-242-1866
Mailing Address - Street 1:143 HUNTER RIDGE RD N
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-2708
Mailing Address - Country:US
Mailing Address - Phone:516-242-1866
Mailing Address - Fax:
Practice Address - Street 1:143 HUNTER RIDGE RD N
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-2708
Practice Address - Country:US
Practice Address - Phone:516-242-1866
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-27
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1021951Other.