Provider Demographics
NPI:1376780080
Name:NUTRTIONAL HEALTH CENTER
Entity Type:Organization
Organization Name:NUTRTIONAL HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETICIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARITA
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLL
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:203-234-0396
Mailing Address - Street 1:100 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:NORTH HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06473-2365
Mailing Address - Country:US
Mailing Address - Phone:203-234-0396
Mailing Address - Fax:203-234-0801
Practice Address - Street 1:100 BROADWAY
Practice Address - Street 2:
Practice Address - City:NORTH HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06473-2365
Practice Address - Country:US
Practice Address - Phone:203-234-0396
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-16
Last Update Date:2009-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000020133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTP817491OtherOXFORD
CT270000020CT02OtherANTHEM
CT5499494OtherAETNA