Provider Demographics
NPI:1376173898
Name:INNOVATIVE HEALTH NUTRITION & FITNESS, PC
Entity Type:Organization
Organization Name:INNOVATIVE HEALTH NUTRITION & FITNESS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-879-3508
Mailing Address - Street 1:23 SUMMERSWEET DR
Mailing Address - Street 2:
Mailing Address - City:MIDDLE ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:11953-2715
Mailing Address - Country:US
Mailing Address - Phone:631-879-3508
Mailing Address - Fax:
Practice Address - Street 1:23 SUMMERSWEET DR
Practice Address - Street 2:
Practice Address - City:MIDDLE ISLAND
Practice Address - State:NY
Practice Address - Zip Code:11953-2715
Practice Address - Country:US
Practice Address - Phone:631-879-3508
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-23
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty