Provider Demographics
NPI:1689425456
Name:PODOB NUTRITION PLLC
Entity Type:Organization
Organization Name:PODOB NUTRITION PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:PODOB
Authorized Official - Suffix:
Authorized Official - Credentials:RDN
Authorized Official - Phone:914-315-9635
Mailing Address - Street 1:110 HILLTOP RD
Mailing Address - Street 2:
Mailing Address - City:ARDSLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10502-1612
Mailing Address - Country:US
Mailing Address - Phone:914-315-9635
Mailing Address - Fax:
Practice Address - Street 1:110 HILLTOP RD
Practice Address - Street 2:
Practice Address - City:ARDSLEY
Practice Address - State:NY
Practice Address - Zip Code:10502-1612
Practice Address - Country:US
Practice Address - Phone:914-315-9635
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-29
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty