Provider Demographics
NPI:1851099675
Name:NUTRISPACE LLC
Entity Type:Organization
Organization Name:NUTRISPACE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:ARPANA
Authorized Official - Middle Name:
Authorized Official - Last Name:BIDNUR
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:347-735-1426
Mailing Address - Street 1:1460 BRONTE CT
Mailing Address - Street 2:
Mailing Address - City:LANSDALE
Mailing Address - State:PA
Mailing Address - Zip Code:19446-5365
Mailing Address - Country:US
Mailing Address - Phone:347-735-1426
Mailing Address - Fax:
Practice Address - Street 1:150 BETHLEHEM PIKE
Practice Address - Street 2:
Practice Address - City:COLMAR
Practice Address - State:PA
Practice Address - Zip Code:18915-9790
Practice Address - Country:US
Practice Address - Phone:215-822-0292
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-21
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center