Provider Demographics
NPI:1962510511
Name:TOWN TOTAL NUTRITION, INC.
Entity Type:Organization
Organization Name:TOWN TOTAL NUTRITION, INC.
Other - Org Name:ADVOCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:P
Authorized Official - Last Name:NAVARRA
Authorized Official - Suffix:
Authorized Official - Credentials:RHP
Authorized Official - Phone:212-213-5570
Mailing Address - Street 1:532 BROADHOLLOW RD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747-3672
Mailing Address - Country:US
Mailing Address - Phone:212-213-5570
Mailing Address - Fax:212-220-0847
Practice Address - Street 1:532 BROADHOLLOW RD
Practice Address - Street 2:SUITE 106
Practice Address - City:MELVILLE
Practice Address - State:NY
Practice Address - Zip Code:11747-3672
Practice Address - Country:US
Practice Address - Phone:212-213-5570
Practice Address - Fax:212-220-0847
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02721406Medicaid
NY0442480002Medicare ID - Type Unspecified