Provider Demographics
NPI:1457010910
Name:NUTRITION SERVICE OF UPSTATE NEW YORK, LLC
Entity Type:Organization
Organization Name:NUTRITION SERVICE OF UPSTATE NEW YORK, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAFFEE
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RDN, CEDRD-S
Authorized Official - Phone:607-732-5646
Mailing Address - Street 1:1003 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:ELMIRA
Mailing Address - State:NY
Mailing Address - Zip Code:14901-1007
Mailing Address - Country:US
Mailing Address - Phone:607-732-5646
Mailing Address - Fax:
Practice Address - Street 1:1003 WALNUT ST
Practice Address - Street 2:
Practice Address - City:ELMIRA
Practice Address - State:NY
Practice Address - Zip Code:14901-1007
Practice Address - Country:US
Practice Address - Phone:607-732-5646
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-13
Last Update Date:2021-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty