Provider Demographics
NPI:1356971998
Name:INTEGRATIVE NUTRITION SOLUTIONS
Entity type:Organization
Organization Name:INTEGRATIVE NUTRITION SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAY
Authorized Official - Middle Name:
Authorized Official - Last Name:WOLKOFF
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CNS, CDN
Authorized Official - Phone:203-231-9580
Mailing Address - Street 1:93 WEDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06705-3611
Mailing Address - Country:US
Mailing Address - Phone:203-231-9580
Mailing Address - Fax:203-597-8656
Practice Address - Street 1:93 WEDGEWOOD DR
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06705-3611
Practice Address - Country:US
Practice Address - Phone:203-231-9580
Practice Address - Fax:203-597-8656
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-23
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Single Specialty