Provider Demographics
NPI:1336186873
Name:PIONEER VALLEY NUTRITION, INC.
Entity Type:Organization
Organization Name:PIONEER VALLEY NUTRITION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:POLLY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:OBREMSKI
Authorized Official - Suffix:
Authorized Official - Credentials:RD, LDN, CDE
Authorized Official - Phone:413-584-2200
Mailing Address - Street 1:39 CARLON DR
Mailing Address - Street 2:
Mailing Address - City:NORTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01060-2374
Mailing Address - Country:US
Mailing Address - Phone:413-584-2200
Mailing Address - Fax:413-584-2255
Practice Address - Street 1:39 CARLON DR
Practice Address - Street 2:
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060-2374
Practice Address - Country:US
Practice Address - Phone:413-584-2200
Practice Address - Fax:413-584-2255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-01
Last Update Date:2009-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2232133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA4609501OtherCIGNA NUMBER
MAMT0840OtherMEDICARE
MA11326384OtherCAQH NUMBER
MAAA59459OtherHARVARD PILGRIM
MALG0035OtherBCBS GROUP NUMBER
MA35122OtherHEALTH NEW ENGLAND