Provider Demographics
NPI:1508317801
Name:SID III,LLC
Entity Type:Organization
Organization Name:SID III,LLC
Other - Org Name:FUTURE FITNESS CENTERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REGISTERED DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:BERYL
Authorized Official - Middle Name:F
Authorized Official - Last Name:KRINSKY
Authorized Official - Suffix:
Authorized Official - Credentials:RDN, LDN
Authorized Official - Phone:215-764-9651
Mailing Address - Street 1:P.O. BOX 18
Mailing Address - Street 2:
Mailing Address - City:WEST BERLIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08091
Mailing Address - Country:US
Mailing Address - Phone:856-753-1800
Mailing Address - Fax:856-753-6200
Practice Address - Street 1:545 N ROUTE 73
Practice Address - Street 2:
Practice Address - City:WEST BERLIN
Practice Address - State:NJ
Practice Address - Zip Code:08091-9242
Practice Address - Country:US
Practice Address - Phone:856-753-1800
Practice Address - Fax:856-753-6200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-21
Last Update Date:2016-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN005313133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty