Provider Demographics
NPI:1063809630
Name:NUTRAPY, LLC
Entity type:Organization
Organization Name:NUTRAPY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:JIMMY
Authorized Official - Middle Name:CHUNG
Authorized Official - Last Name:DUONG
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:508-685-4033
Mailing Address - Street 1:412 WASHINGTON ST
Mailing Address - Street 2:(INSIDE NORWELL ATHLETIC CENTER)
Mailing Address - City:NORWELL
Mailing Address - State:MA
Mailing Address - Zip Code:02061-2056
Mailing Address - Country:US
Mailing Address - Phone:508-685-4033
Mailing Address - Fax:
Practice Address - Street 1:412 WASHINGTON ST
Practice Address - Street 2:(INSIDE NORWELL ATHLETIC CENTER)
Practice Address - City:NORWELL
Practice Address - State:MA
Practice Address - Zip Code:02061-2056
Practice Address - Country:US
Practice Address - Phone:508-685-4033
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-22
Last Update Date:2015-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9250302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization