Provider Demographics
NPI:1023831849
Name:HEIRLOOM NUTRITION PLLC
Entity type:Organization
Organization Name:HEIRLOOM NUTRITION PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:ND
Authorized Official - Phone:860-759-4119
Mailing Address - Street 1:2969 WHITNEY AVE STE 1M
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06518-2556
Mailing Address - Country:US
Mailing Address - Phone:203-988-2150
Mailing Address - Fax:
Practice Address - Street 1:2969 WHITNEY AVE STE 1M
Practice Address - Street 2:
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06518-2556
Practice Address - Country:US
Practice Address - Phone:203-988-2150
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-01
Last Update Date:2024-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Single Specialty