Provider Demographics
NPI:1548924624
Name:NEW MOON NUTRITION, LLC
Entity type:Organization
Organization Name:NEW MOON NUTRITION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER & REGISTERED DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:MEGHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KACMARCIK
Authorized Official - Suffix:
Authorized Official - Credentials:RD, LDN
Authorized Official - Phone:508-443-4262
Mailing Address - Street 1:319 CENTRE AVE # 255
Mailing Address - Street 2:
Mailing Address - City:ROCKLAND
Mailing Address - State:MA
Mailing Address - Zip Code:02370-2613
Mailing Address - Country:US
Mailing Address - Phone:508-443-4262
Mailing Address - Fax:
Practice Address - Street 1:30 SURREY LN
Practice Address - Street 2:
Practice Address - City:EAST BRIDGEWATER
Practice Address - State:MA
Practice Address - Zip Code:02333-3109
Practice Address - Country:US
Practice Address - Phone:084-443-4262
Practice Address - Fax:508-233-2178
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-26
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty