Club la Maison, Inc.

Primary specialty

Registered DietitianTaxonomy code 133V00000X

Legal business name

CLUB LA MAISON, INC.

Practice address

215 Sugartown Rd
Wayne, PA 19087-3137

Phone

(610) 964-8800

Fax

(610) 964-9233

NPI assigned

Apr 12, 2016

Organization subpart

No

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

Authorized official

Name

Paul Meshyock

Title

General Manager

Phone

(610) 964-8800

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1460419200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1464652800000",
    "number": "1487018818",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "215 SUGARTOWN RD",
            "city": "WAYNE",
            "state": "PA",
            "postal_code": "190873137",
            "telephone_number": "610-964-8800",
            "fax_number": "610-964-9233"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "215 SUGARTOWN RD",
            "city": "WAYNE",
            "state": "PA",
            "postal_code": "190873137",
            "telephone_number": "610-964-8800",
            "fax_number": "610-964-9233"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLUB LA MAISON, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-04-12",
        "last_updated": "2016-05-31",
        "status": "A",
        "authorized_official_last_name": "MESHYOCK",
        "authorized_official_first_name": "PAUL",
        "authorized_official_title_or_position": "GENERAL MANAGER",
        "authorized_official_telephone_number": "610-964-8800"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dietitian, Registered",
            "state": "PA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kelly Brynn Cicippio, M.A.
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• Brian Patrick Cleary, PT
• William Albert Cleveland, D.M.D.
• Sarah Clothier
• Carol A. Cobb-Nettleton, D.S.W.
• Andrew Joseph Cocco
• Benjamin R Cofield
• Alexandra Cohen
• Lauren Cohen

• Registered Dietitian in Wayne, PA
• Providers in Wayne, PA by specialty
• Registered Dietitian in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 31, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.