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Organization
GEORGETOWN FITNESS INC
Active
Organization
GEORGETOWN FITNESS INC
Active
Other names
Georgetown Fitness Inc
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DAVID JACOBS JR. (OWNER)
(607) 280-3441
Entity
Organization
Contact information
Practice address
5225 SHERIDAN DR, WILLIAMSVILLE, NY 14221-3573
(716) 580-3362
Mailing address
5225 SHERIDAN DR, WILLIAMSVILLE, NY 14221-3573
(607) 280-3441
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
—
—
133VN1006X
Metabolic Nutrition Registered Dietitian
—
—
133VN1201X
Obesity and Weight Management Nutrition Registered Dietitian
—
—
133VN1301X
Oncology Nutrition Registered Dietitian
—
—
133VN1501X
Sports Dietetics Nutrition Registered Dietitian
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
010418-01
NY STATE CERTIFICATION
NY
Enumeration date
12/30/2020
Last updated
01/25/2021
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