Provider Demographics
NPI:1649860719
Name:GREENE NUTRITION, LLC
Entity type:Organization
Organization Name:GREENE NUTRITION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/REGISTERED DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:MURACHVER
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RD, LDN, CDE
Authorized Official - Phone:617-356-7037
Mailing Address - Street 1:7 ABBY RD
Mailing Address - Street 2:
Mailing Address - City:WESTFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01886-4531
Mailing Address - Country:US
Mailing Address - Phone:603-494-5234
Mailing Address - Fax:
Practice Address - Street 1:525 MASSACHUSETTS AVE STE 101C
Practice Address - Street 2:
Practice Address - City:ACTON
Practice Address - State:MA
Practice Address - Zip Code:01720-2963
Practice Address - Country:US
Practice Address - Phone:617-356-7037
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-22
Last Update Date:2021-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1760802797Medicaid