Provider Demographics
NPI:1124458393
Name:DOWNINGTOWN NUTRITION & WEIGHT MANAGEMENT CENTER
Entity type:Organization
Organization Name:DOWNINGTOWN NUTRITION & WEIGHT MANAGEMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:O'NEILL
Authorized Official - Last Name:BARR
Authorized Official - Suffix:
Authorized Official - Credentials:RDN, CDCES
Authorized Official - Phone:610-269-6300
Mailing Address - Street 1:506 E LANCASTER AVE BSMT LEVEL
Mailing Address - Street 2:
Mailing Address - City:DOWNINGTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19335-2776
Mailing Address - Country:US
Mailing Address - Phone:610-269-6300
Mailing Address - Fax:855-230-0193
Practice Address - Street 1:506 E LANCASTER AVE BSMT LEVEL
Practice Address - Street 2:
Practice Address - City:DOWNINGTOWN
Practice Address - State:PA
Practice Address - Zip Code:19335-2776
Practice Address - Country:US
Practice Address - Phone:610-269-6300
Practice Address - Fax:855-230-0193
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-25
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN002850133V00000X
PADN0000425133V00000X
PADN003201133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA673AMedicare UPIN