Provider Demographics
NPI:1922769165
Name:ERICA LEON NUTRITION LLC
Entity Type:Organization
Organization Name:ERICA LEON NUTRITION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:
Authorized Official - Last Name:RAMOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-828-0028
Mailing Address - Street 1:9 SPRINGWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:ARDSLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10502-2506
Mailing Address - Country:US
Mailing Address - Phone:914-693-2174
Mailing Address - Fax:833-641-2564
Practice Address - Street 1:9 SPRINGWOOD AVE
Practice Address - Street 2:
Practice Address - City:ARDSLEY
Practice Address - State:NY
Practice Address - Zip Code:10502-2506
Practice Address - Country:US
Practice Address - Phone:914-693-2174
Practice Address - Fax:833-641-2564
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-09
Last Update Date:2022-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty