Provider Demographics
NPI:1154957371
Name:NUTRITION CARE P.C.
Entity type:Organization
Organization Name:NUTRITION CARE P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:RAFAILOVA
Authorized Official - Suffix:
Authorized Official - Credentials:RD, CDN
Authorized Official - Phone:917-498-4211
Mailing Address - Street 1:2900 E 29TH ST APT 2F
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-2272
Mailing Address - Country:US
Mailing Address - Phone:917-498-4211
Mailing Address - Fax:347-394-4995
Practice Address - Street 1:1117 BRIGHTON BEACH AVE FL 3
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-5999
Practice Address - Country:US
Practice Address - Phone:917-498-4211
Practice Address - Fax:347-394-4995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-19
Last Update Date:2020-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174H00000XOther Service ProvidersHealth EducatorGroup - Single Specialty