FUNCTIONAL NUTRITION OF WESTERN NEW YORK, PLLC (NPI# 1811488240) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1811488240 |
| Entity Type | Organization |
| Organization Name | FUNCTIONAL NUTRITION OF WESTERN NEW YORK, PLLC |
| Practice Address |
352 Brentwood Dr Youngstown NY 14174-1404 |
| Practice Telephone | 7165315207 |
| Mailing Telephone | 7165315207 |
| Enumeration Date | 2018-05-22 |
| Last Update Date | 2018-05-22 |
| Authorized Official Name | MS. ELIZABETH ANN MILLER (OWNER/REGISTERED DIETITIAN) |
| Authorized Official Telephone | 7165315207 |
| Authorized Official Credential | MS, RDN, CDN |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QH0100X |
Clinic/Center Specialization: Health Service |
Ambulatory Health Care Facilities |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| New York State Corporations | FUNCTIONAL NUTRITION OF WESTERN NEW YORK, PLLC | 352 Brentwood Drive, Youngstown, Ny 14174 |
| Street Address |
352 BRENTWOOD DR |
| City | YOUNGSTOWN |
| State | NY |
| Zip Code | 14174-1404 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861934465 | Elizabeth Ann Miller | Dietitian, Registered | 352 Brentwood Dr, Youngstown, NY 14174-1404 | 2016-11-14 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285163089 | Andrea Rose Downie | Registered Nurse | 1334 Swann Road, Youngstown, NY 14174 | 2017-06-06 |
| 1457612525 | Melissa M. Ruta | Specialist | 461 Riverview Dr., Youngstown, NY 14174 | 2012-06-05 |
| 1376697375 | Lewiston Porter Central School District | Local Education Agency (LEA) | 4601 Creek Rd., Youngstown, NY 14174 | 2007-01-23 |
| 1417908419 | Rama Bojedla | Internal Medicine | 120 Lockport St, Youngstown, NY 14174-1006 | 2006-05-14 |
| 1730369679 | Laurie Ann Hewitt | Pharmacist | 214 Lockport St, Youngstown, NY 14174-1008 | 2007-11-08 |
| 1568571883 | Rite Aid of New York Inc | Durable Medical Equipment & Medical Supplies | 214 Lockport Street, Youngstown, NY 14174-1008 | 2006-08-30 |
| 1871124842 | Emily Alyssa Le | Pharmacist | 214 Lockport St, Youngstown, NY 14174-1008 | 2020-01-29 |
| 1154641512 | Nitasha Khurana | Pharmacist | 214 Lockport St, Youngstown, NY 14174-1008 | 2010-06-09 |
| 1285892612 | Lisa Nasca | Acupuncturist | 445 Main St, Youngstown, NY 14174-1016 | 2008-06-02 |
| 1043480106 | Glenda Sue Christian | Point of Service | 3134 Oak Ave, Youngstown, NY 14174-1061 | 2008-03-05 |
| Find all providers in zip 14174 | ||||
| Taxonomy Code | 261QH0100X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Health Service |
| Definition to come... |
| Notes: [7/1/2006: modified title] |
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| City | YOUNGSTOWN |
| Zip Code | 14174 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.