Provider Demographics
NPI:1336992395
Name:REMOTE DIETITIANS LLC
Entity Type:Organization
Organization Name:REMOTE DIETITIANS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BALSAMO
Authorized Official - Suffix:
Authorized Official - Credentials:MS,RDN
Authorized Official - Phone:845-825-9458
Mailing Address - Street 1:102 US HIGHWAY 89 UNIT 4010
Mailing Address - Street 2:
Mailing Address - City:ALPINE
Mailing Address - State:WY
Mailing Address - Zip Code:83128-1042
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:317 SNAKE RIVER DRIVE
Practice Address - Street 2:
Practice Address - City:ALPINE
Practice Address - State:WY
Practice Address - Zip Code:83128
Practice Address - Country:US
Practice Address - Phone:845-825-9458
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-09
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty