Provider Demographics
NPI:1689655359
Name:TOWN TOTAL NUTRITION INC
Entity type:Organization
Organization Name:TOWN TOTAL NUTRITION INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:NAVARRA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:212-213-5570
Mailing Address - Street 1:6 E 32ND ST FL 5
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-5422
Mailing Address - Country:US
Mailing Address - Phone:212-213-5570
Mailing Address - Fax:212-213-5616
Practice Address - Street 1:6 E 32ND ST FL 5
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-5422
Practice Address - Country:US
Practice Address - Phone:212-213-5570
Practice Address - Fax:212-213-5616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-09
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X, 3336L0003X, 3336S0011X
NY0211333336H0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3338882OtherNCPDP PROVIDER IDENTIFICATION NUMBER
NY01279010Medicaid
NY01279010Medicaid