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Organization
NUTRIALL WELLNESS CENTER LLC
Active
Organization
NUTRIALL WELLNESS CENTER LLC
Active
Other names
NUTRIALL WELLNESS CENTER
Organization subpart
No
Provider details
NPI number
Authorized official
XIAOFANG TAN (REGISTERED DIETITIAN)
(929) 777-4933
Entity
Organization
Contact information
Practice address
3347 213TH ST, BAYSIDE, NY 11361-1560
(929) 777-4933
(888) 370-1981
Mailing address
3347 213TH ST, BAYSIDE, NY 11361-1560
(929) 777-4933
(888) 370-1981
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
—
—
133VN1004X
Pediatric Nutrition Registered Dietitian
—
—
Other
Enumeration date
09/13/2022
Last updated
05/09/2023
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