Provider Demographics
NPI:1639534258
Name:APPLE A DAY NUTRITION SERVICES LLC
Entity Type:Organization
Organization Name:APPLE A DAY NUTRITION SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:COLAVITO
Authorized Official - Suffix:
Authorized Official - Credentials:RD LDN
Authorized Official - Phone:610-248-6644
Mailing Address - Street 1:PO BOX 256
Mailing Address - Street 2:
Mailing Address - City:MOUNT BETHEL
Mailing Address - State:PA
Mailing Address - Zip Code:18343-0256
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:327 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:EAST BANGOR
Practice Address - State:PA
Practice Address - Zip Code:18013-2224
Practice Address - Country:US
Practice Address - Phone:484-294-3662
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-25
Last Update Date:2015-12-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN005415133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty