Provider Demographics
NPI:1740844257
Name:GATEWAY FXMED
Entity type:Organization
Organization Name:GATEWAY FXMED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RD
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:HUFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-799-7378
Mailing Address - Street 1:7 SHANNON CIR
Mailing Address - Street 2:
Mailing Address - City:WESTFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01886-3943
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7 SHANNON CIR
Practice Address - Street 2:
Practice Address - City:WESTFORD
Practice Address - State:MA
Practice Address - Zip Code:01886-3943
Practice Address - Country:US
Practice Address - Phone:978-799-7378
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-30
Last Update Date:2019-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty