Provider Demographics
NPI:1548154040
Name:ELLA PODHURST NUTRITION LLC
Entity type:Organization
Organization Name:ELLA PODHURST NUTRITION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELLA
Authorized Official - Middle Name:
Authorized Official - Last Name:PODHURST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-339-2313
Mailing Address - Street 1:1908 BEACON ST APT 3
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02445-1987
Mailing Address - Country:US
Mailing Address - Phone:631-339-2313
Mailing Address - Fax:
Practice Address - Street 1:1908 BEACON ST APT 3
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02445-1987
Practice Address - Country:US
Practice Address - Phone:631-339-2313
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-07
Last Update Date:2025-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1497514202Medicaid