Provider Demographics
NPI:1902002983
Name:NUTRITION IMPROVEMENT CENTER
Entity Type:Organization
Organization Name:NUTRITION IMPROVEMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:IRIS
Authorized Official - Middle Name:R
Authorized Official - Last Name:EPSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-362-1300
Mailing Address - Street 1:978 RTE. 45 NORTHSIDE PLAZA
Mailing Address - Street 2:SUITE 107
Mailing Address - City:POMONA
Mailing Address - State:NY
Mailing Address - Zip Code:10970
Mailing Address - Country:US
Mailing Address - Phone:845-362-1300
Mailing Address - Fax:845-362-1308
Practice Address - Street 1:978 RTE. 45 NORTHSIDE PLAZA
Practice Address - Street 2:SUITE 107
Practice Address - City:POMONA
Practice Address - State:NY
Practice Address - Zip Code:10970
Practice Address - Country:US
Practice Address - Phone:845-362-1300
Practice Address - Fax:845-362-1308
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003101-1133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY9859218002OtherCIGNA
NY7248335OtherAETNA
NY8099864OtherGHI
NYP2524572OtherOXFORD
NY2184571OtherUNITED
NY9859218002OtherCIGNA