Provider Demographics
NPI:1952548554
Name:NY-PENN NUTRITION SERVICES, INC.
Entity type:Organization
Organization Name:NY-PENN NUTRITION SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:HASEMANN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, RD
Authorized Official - Phone:607-770-6221
Mailing Address - Street 1:74 LA GRANGE ST
Mailing Address - Street 2:
Mailing Address - City:BINGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13905-1718
Mailing Address - Country:US
Mailing Address - Phone:607-770-6221
Mailing Address - Fax:607-770-6221
Practice Address - Street 1:74 LA GRANGE ST
Practice Address - Street 2:
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13905-1718
Practice Address - Country:US
Practice Address - Phone:607-770-6221
Practice Address - Fax:607-770-6221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-19
Last Update Date:2009-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000732251B00000X
NY804448 (R DIETITIAN)251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
1669539284OtherNPI
RA6557Medicare PIN
BA0550Medicare PIN