NPIMap

Organization Active NPI

Corporate Wellness Nutrition LLC

  • Registered Dietitian
  • Bala Cynwyd, PA
National Provider Identifier
1316257553
Registry record updated Oct 1, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered DietitianTaxonomy code 133V00000X
License
DN003782 Issued in PA
Legal business name
CORPORATE WELLNESS NUTRITION LLC
Practice address
150 Monument Rd Ste 207
Bala Cynwyd, PA 19004-1725
Phone
(800) 484-7720
Fax
(215) 628-3262
NPI assigned
Oct 20, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 1, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Brian Davidson
Title
Executive Director
Phone
(800) 484-7720

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Registered DietitianGroup: 193400000X SINGLE SPECIALTY GROUP 133V00000X DN003782 PA Primary

Addresses

Primary practice location

150 Monument Rd Ste 207
Bala Cynwyd, PA 19004-1725

Mailing address

150 Monument Rd Ste 207
Bala Cynwyd, PA 19004-1725
Phone (800) 484-7720

Other practice location 1

1839 Manton Street
Philadelphia, PA 19146
Phone (215) 827-6701

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20260504005390 PA Part B Supplier - Clinic/Group Practice 3173772753 Receives reassigned benefits from 1 practitioner
Practice locations: Bala Cynwyd, PA

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

826 71st St
Ste 3
Miami Beach, FL 33141

2912 Highwoods Blvd
Raleigh, NC 27604
Phone (800) 699-8011

Practitioners & affiliated clinicians

Practitioners 26

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 26

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1287532800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1759276800000",
    "number": "1316257553",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "150 MONUMENT RD STE 207",
            "city": "BALA CYNWYD",
            "state": "PA",
            "postal_code": "190041725",
            "telephone_number": "800-484-7720",
            "fax_number": "215-628-3262"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "150 MONUMENT RD STE 207",
            "city": "BALA CYNWYD",
            "state": "PA",
            "postal_code": "190041725",
            "telephone_number": "800-484-7720",
            "fax_number": "215-628-3262"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1839 Manton Street",
            "address_purpose": "LOCATION",
            "city": "Philadelphia",
            "state": "PA",
            "postal_code": "19146",
            "country_code": "US",
            "telephone_number": "215-827-6701",
            "fax_number": "800-258-1426",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "CORPORATE WELLNESS NUTRITION LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-10-20",
        "last_updated": "2025-10-01",
        "certification_date": "2025-10-01",
        "status": "A",
        "authorized_official_last_name": "DAVIDSON",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "800-484-7720"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dietitian, Registered",
            "state": "PA",
            "license": "DN003782",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bala Cynwyd, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.