Provider Demographics
NPI:1750140810
Name:GREATER BOSTON NUTRITION LLC
Entity type:Organization
Organization Name:GREATER BOSTON NUTRITION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:
Authorized Official - Last Name:ANGELILLO
Authorized Official - Suffix:
Authorized Official - Credentials:RD, LDN
Authorized Official - Phone:617-564-0140
Mailing Address - Street 1:95 WALTHAM ST APT 3
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02472-4815
Mailing Address - Country:US
Mailing Address - Phone:617-564-0140
Mailing Address - Fax:
Practice Address - Street 1:95 WALTHAM ST APT 3
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:MA
Practice Address - Zip Code:02472-4815
Practice Address - Country:US
Practice Address - Phone:617-564-0140
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-18
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty