Provider Demographics
NPI:1013242239
Name:TRUSTEES OF BOSTON UNIVERSITY
Entity Type:Organization
Organization Name:TRUSTEES OF BOSTON UNIVERSITY
Other - Org Name:SARGENT CHOICE NUTRITION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:
Authorized Official - Last Name:ZAWACKI
Authorized Official - Suffix:
Authorized Official - Credentials:DRPH, RD
Authorized Official - Phone:617-358-5065
Mailing Address - Street 1:635 COMMONWEALTH AVE
Mailing Address - Street 2:6TH FLOOR
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215-1605
Mailing Address - Country:US
Mailing Address - Phone:617-353-2721
Mailing Address - Fax:617-358-5460
Practice Address - Street 1:635 COMMONWEALTH AVE.
Practice Address - Street 2:6TH FLOOR
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-1605
Practice Address - Country:US
Practice Address - Phone:617-353-2721
Practice Address - Fax:617-358-5460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-06
Last Update Date:2014-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Single Specialty