Provider Demographics
NPI:1902127053
Name:YOURS NUTRITIONALLY LLC
Entity Type:Organization
Organization Name:YOURS NUTRITIONALLY LLC
Other - Org Name:NUTRITIONALLY YOURS
Other - Org Type:Other Name
Authorized Official - Title/Position:REGISTERED DIETITIAN
Authorized Official - Prefix:MS
Authorized Official - First Name:RAIZY
Authorized Official - Middle Name:
Authorized Official - Last Name:WEINREB
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:732-803-5310
Mailing Address - Street 1:1170 OCEAN PKWY
Mailing Address - Street 2:APT 7F
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-4053
Mailing Address - Country:US
Mailing Address - Phone:718-377-6516
Mailing Address - Fax:
Practice Address - Street 1:1170 OCEAN PKWY
Practice Address - Street 2:APT 7F
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-4053
Practice Address - Country:US
Practice Address - Phone:718-377-6516
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-11
Last Update Date:2016-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty