Provider Demographics
NPI:1326800228
Name:WISE BITES NUTRITION PLLC
Entity Type:Organization
Organization Name:WISE BITES NUTRITION PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BINA
Authorized Official - Middle Name:
Authorized Official - Last Name:GOYKADOSH
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RDN, CDN
Authorized Official - Phone:347-770-2462
Mailing Address - Street 1:136 BAKER HILL RD
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11023-1716
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:136 BAKER HILL RD
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11023-1716
Practice Address - Country:US
Practice Address - Phone:347-770-2462
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-25
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service