Provider Demographics
NPI:1861515678
Name:NUTRONICS TM, INC.
Entity type:Organization
Organization Name:NUTRONICS TM, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:GERBSTADT
Authorized Official - Suffix:
Authorized Official - Credentials:MD, RD
Authorized Official - Phone:814-571-2369
Mailing Address - Street 1:3202 GRANADA WAY
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16601-3528
Mailing Address - Country:US
Mailing Address - Phone:814-571-2369
Mailing Address - Fax:814-237-4917
Practice Address - Street 1:3202 GRANADA WAY
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16601-3528
Practice Address - Country:US
Practice Address - Phone:814-571-2369
Practice Address - Fax:814-237-4917
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN001036133V00000X
FLND4446133V00000X
PAMD049226L207L00000X
FLME90451207L00000X
HIMD11105207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty
Not Answered207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAC93928Medicare UPIN
PATH731611Medicare ID - Type Unspecified