Organization
NUTRISOURCE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. NICOLETTE M. PACE MS RD CDE CDN CFCS (PRESIDENT MANAGING DIRECTOR)
(516) 482-3100
Entity
Organization
Contact information
Practice address
295 NORTHERN BLVD, SUITE 105, GREAT NECK, NY 11021-4706
(516) 482-3100
(516) 482-3131
Mailing address
295 NORTHERN BLVD, SUITE 105, GREAT NECK, NY 11021-4706
(516) 482-3100
(516) 482-3131
Taxonomy
Speciality
Code
Description
License number
State
133VN1006X
Metabolic Nutrition Registered Dietitian
Primary
005258
NY
Other
Enumeration date
08/21/2007
Last updated
11/22/2011
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