Provider Demographics
NPI:1942636063
Name:MEDICAL NUTRITION CONSULTING OF MEDIA LLC
Entity Type:Organization
Organization Name:MEDICAL NUTRITION CONSULTING OF MEDIA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN/NUTRITIONIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:ELENA
Authorized Official - Last Name:TOMEZSKO
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:215-238-0753
Mailing Address - Street 1:604 S WASHINGTON SQ
Mailing Address - Street 2:1317
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19106-4118
Mailing Address - Country:US
Mailing Address - Phone:215-238-0753
Mailing Address - Fax:
Practice Address - Street 1:604 S WASHINGTON SQ
Practice Address - Street 2:1317
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19106-4118
Practice Address - Country:US
Practice Address - Phone:215-238-0753
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-20
Last Update Date:2013-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN001051133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty