Provider Demographics
NPI:1740414770
Name:NORTHEAST NUTRITIONALS, LLC
Entity Type:Organization
Organization Name:NORTHEAST NUTRITIONALS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHEPELEFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-359-1599
Mailing Address - Street 1:8 SHIRE DR
Mailing Address - Street 2:SUITE #3
Mailing Address - City:NORFOLK
Mailing Address - State:MA
Mailing Address - Zip Code:02056-1580
Mailing Address - Country:US
Mailing Address - Phone:800-359-1599
Mailing Address - Fax:774-847-7944
Practice Address - Street 1:8 SHIRE DR
Practice Address - Street 2:SUITE #3
Practice Address - City:NORFOLK
Practice Address - State:MA
Practice Address - Zip Code:02056-1580
Practice Address - Country:US
Practice Address - Phone:800-359-1599
Practice Address - Fax:774-847-7944
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-05
Last Update Date:2011-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA6314670001Medicare NSC