Provider Demographics
NPI:1558060178
Name:APEX FUNCTIONAL NUTRITION LLC
Entity Type:Organization
Organization Name:APEX FUNCTIONAL NUTRITION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:VERA
Authorized Official - Middle Name:
Authorized Official - Last Name:KOTLYAR
Authorized Official - Suffix:
Authorized Official - Credentials:RDN, LDN
Authorized Official - Phone:347-967-6410
Mailing Address - Street 1:2983 FARMHOUSE DR
Mailing Address - Street 2:
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27502-7060
Mailing Address - Country:US
Mailing Address - Phone:347-967-6410
Mailing Address - Fax:919-578-4371
Practice Address - Street 1:200 HAWKINS AVE STE 103D
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:NC
Practice Address - Zip Code:27330-4324
Practice Address - Country:US
Practice Address - Phone:347-967-6410
Practice Address - Fax:919-578-4371
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-02
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty