Provider Demographics
NPI:1982209680
Name:EVERLONG INC.
Entity Type:Organization
Organization Name:EVERLONG INC.
Other - Org Name:EVERLONG NUTRITION, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:ADI
Authorized Official - Middle Name:
Authorized Official - Last Name:WYSHOGROD
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:617-249-3253
Mailing Address - Street 1:265 CHELMSFORD ST STE 7
Mailing Address - Street 2:
Mailing Address - City:CHELMSFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01824-2335
Mailing Address - Country:US
Mailing Address - Phone:617-249-3253
Mailing Address - Fax:866-303-5661
Practice Address - Street 1:44 PORTLAND ST FL 4
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01608-2023
Practice Address - Country:US
Practice Address - Phone:617-249-3253
Practice Address - Fax:866-303-5661
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-01
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty