Provider Demographics
NPI:1053615062
Name:METROWEST NUTRITION
Entity type:Organization
Organization Name:METROWEST NUTRITION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:GARDNER
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RD
Authorized Official - Phone:617-332-2282
Mailing Address - Street 1:10 LANGLEY RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02459-1972
Mailing Address - Country:US
Mailing Address - Phone:617-332-2282
Mailing Address - Fax:617-244-0884
Practice Address - Street 1:10 LANGLEY RD
Practice Address - Street 2:SUITE 300
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02459-1972
Practice Address - Country:US
Practice Address - Phone:617-332-2282
Practice Address - Fax:617-244-0884
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-05
Last Update Date:2011-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2055261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center