Provider Demographics
NPI:1518318922
Name:NEWMARK NUTRITION, LLC
Entity Type:Organization
Organization Name:NEWMARK NUTRITION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAYNE
Authorized Official - Middle Name:
Authorized Official - Last Name:NEWMARK
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:602-264-3587
Mailing Address - Street 1:5182 W VISTA AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85301-8610
Mailing Address - Country:US
Mailing Address - Phone:602-264-3587
Mailing Address - Fax:
Practice Address - Street 1:202 E EARLL DR STE 425
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012-2649
Practice Address - Country:US
Practice Address - Phone:602-264-3587
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-27
Last Update Date:2019-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, MetabolicGroup - Single Specialty