Nutrition Clinic

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

NUTRITION CLINIC

Practice address

1003 Walnut Street
Elmira, NY 14901

Phone

(607) 732-5646

Fax

(607) 732-0373

NPI assigned

Dec 12, 2006

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Charlie A Jenkins

Title

Program Manager

Phone

(607) 732-5646

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1165881600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1578624078",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1003 WALNUT STREET",
            "city": "ELMIRA",
            "state": "NY",
            "postal_code": "14901",
            "telephone_number": "607-732-5646",
            "fax_number": "607-732-0373"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1003 WALNUT STREET",
            "city": "ELMIRA",
            "state": "NY",
            "postal_code": "14901",
            "telephone_number": "607-732-5646",
            "fax_number": "607-732-0373"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NUTRITION CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-12",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "JENKINS",
        "authorized_official_first_name": "CHARLIE",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PROGRAM MANAGER",
        "authorized_official_telephone_number": "607-732-5646"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Heather Ann Novotny, PA-C
• John J Novotny, MD
• Bedelia Colleen Nowak, R.D.
• Valerie Ann Nucera, BSN
• Luciano Adolfo Nunez Bragayrac, M.D.
• Nutrition Service of Upstate New York, LLC
• Ny Urgent Care Practice, P.C. (Five Star Urgent Care Big Flats)
• Nys Office of Mental Health
• Nys Office of Mental Health
• Nysarc Inc., Chemung County Chapter

• Family Medicine Physician in Elmira, NY
• Providers in Elmira, NY by specialty
• Family Medicine Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.