Provider Demographics
NPI:1477809416
Name:NOURISH HEALTH WITH FOOD FOR LIFE LLC
Entity Type:Organization
Organization Name:NOURISH HEALTH WITH FOOD FOR LIFE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MONA
Authorized Official - Middle Name:
Authorized Official - Last Name:SIGAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:781-632-7205
Mailing Address - Street 1:2 BOURBON ST
Mailing Address - Street 2:SUITE LL 105
Mailing Address - City:PEABODY
Mailing Address - State:MA
Mailing Address - Zip Code:01960-1384
Mailing Address - Country:US
Mailing Address - Phone:978-717-5804
Mailing Address - Fax:
Practice Address - Street 1:2 BOURBON ST
Practice Address - Street 2:SUITE LL 105
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960-1384
Practice Address - Country:US
Practice Address - Phone:781-632-7205
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-27
Last Update Date:2014-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA789592083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive MedicineGroup - Multi-Specialty