Provider Demographics
NPI:1801164942
Name:EATWISERX LLC
Entity type:Organization
Organization Name:EATWISERX LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:B
Authorized Official - Last Name:FREEDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-612-3430
Mailing Address - Street 1:PO BOX 4876
Mailing Address - Street 2:
Mailing Address - City:GREENWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06831-0417
Mailing Address - Country:US
Mailing Address - Phone:203-612-3430
Mailing Address - Fax:215-283-1919
Practice Address - Street 1:45 PERKINS RD
Practice Address - Street 2:GREENWICH
Practice Address - City:GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06830-3510
Practice Address - Country:US
Practice Address - Phone:203-612-3430
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-04
Last Update Date:2013-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005273133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty