Provider Demographics
NPI:1629691795
Name:CITY NUTRITION LLC
Entity Type:Organization
Organization Name:CITY NUTRITION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TARA
Authorized Official - Middle Name:B
Authorized Official - Last Name:MILHEM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-898-5599
Mailing Address - Street 1:4611 12TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11219-2539
Mailing Address - Country:US
Mailing Address - Phone:305-898-5599
Mailing Address - Fax:
Practice Address - Street 1:4611 12TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11219-2539
Practice Address - Country:US
Practice Address - Phone:305-898-5599
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-24
Last Update Date:2021-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty