1255833653 NPI number — TRUTH & LIFE NUTRITION CONSULTANTS INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255833653 NPI number — TRUTH & LIFE NUTRITION CONSULTANTS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TRUTH & LIFE NUTRITION CONSULTANTS INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1255833653
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/02/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8 RUE DE VIN DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MARLBORO
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12542-5953
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
254 ROUTE 17K STE 203
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWBURGH
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12550-8300
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-913-7737
Provider Business Practice Location Address Fax Number:
877-291-6044
Provider Enumeration Date:
03/02/2018

Additional Information

Authorized Official

Authorized Official Last Name:
YOUNG
Authorized Official First Name:
PHYLLIS
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
845-913-7737

Provider Taxonomy Codes

  • Taxonomy code: 261QH0100X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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