Provider Demographics
NPI:1134965973
Name:BODY LAB
Entity type:Organization
Organization Name:BODY LAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:GERARD
Authorized Official - Last Name:ALLEVA
Authorized Official - Suffix:
Authorized Official - Credentials:MLT
Authorized Official - Phone:860-616-8549
Mailing Address - Street 1:66 GATES FARM RD
Mailing Address - Street 2:
Mailing Address - City:GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06033-3219
Mailing Address - Country:US
Mailing Address - Phone:860-616-8549
Mailing Address - Fax:
Practice Address - Street 1:300 ALUMNI RD FL 2
Practice Address - Street 2:
Practice Address - City:NEWINGTON
Practice Address - State:CT
Practice Address - Zip Code:06111-1868
Practice Address - Country:US
Practice Address - Phone:860-578-8020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-02
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133VN1201XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Obesity and Weight ManagementGroup - Multi-Specialty
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental HealthGroup - Multi-Specialty
No174H00000XOther Service ProvidersHealth EducatorGroup - Multi-Specialty