Provider Demographics
NPI:1982290854
Name:HEALING NUTRITION LLC
Entity type:Organization
Organization Name:HEALING NUTRITION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DORINA
Authorized Official - Middle Name:
Authorized Official - Last Name:KORDUNOVA
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:718-594-4794
Mailing Address - Street 1:811 SOUTHERN BLVD
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10459-5202
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:811 SOUTHERN BLVD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10459-5202
Practice Address - Country:US
Practice Address - Phone:720-491-1224
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-15
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty