Provider Demographics
NPI:1215612759
Name:DANA J FRYER NUTRITION LLC
Entity type:Organization
Organization Name:DANA J FRYER NUTRITION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, REGISTERED DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:DANA
Authorized Official - Middle Name:JENNIFER
Authorized Official - Last Name:FRYER
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:203-450-4309
Mailing Address - Street 1:258 HARVARD ST # 342
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-2904
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:96 NAPLES RD APT 5
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-5735
Practice Address - Country:US
Practice Address - Phone:203-450-4309
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-21
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service