Provider Demographics
NPI:1437794310
Name:DIAMOND NUTRITION COUNSELING, INC
Entity Type:Organization
Organization Name:DIAMOND NUTRITION COUNSELING, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:DIAMOND
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RD, LDN, CEO
Authorized Official - Phone:215-240-7883
Mailing Address - Street 1:5800 ARLINGTON AVE APT 6D
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10471-1408
Mailing Address - Country:US
Mailing Address - Phone:215-240-7883
Mailing Address - Fax:
Practice Address - Street 1:589 SKIPPAK PIKE
Practice Address - Street 2:400
Practice Address - City:BLUE BELL
Practice Address - State:PA
Practice Address - Zip Code:19422-2148
Practice Address - Country:US
Practice Address - Phone:215-240-7883
Practice Address - Fax:215-240-7868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-14
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103505118Medicaid
PA103766016-0001Medicaid