Functional Nutrition of Western New York, PLLC

Primary specialty

Health Service Clinic/CenterTaxonomy code 261QH0100X

Legal business name

FUNCTIONAL NUTRITION OF WESTERN NEW YORK, PLLC

Practice address

352 Brentwood Dr
Youngstown, NY 14174-1404

Phone

(716) 531-5207

NPI assigned

May 22, 2018

Organization subpart

No

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

Authorized official

Name

Ms. Elizabeth Ann Miller, MS, RDN, CDN

Title

Owner/Registered Dietitian

Phone

(716) 531-5207

Specialties & licenses 1

Addresses

Practitioners 1

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

• Elizabeth Ann Hartz, M.S., R.D.N., C.D.N

  • Registered Dietitian
  • Lewiston, NY
  • NPI 1861934465
  NPD

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

{
    "created_epoch": "1526947200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1526947200000",
    "number": "1811488240",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "352 BRENTWOOD DR",
            "city": "YOUNGSTOWN",
            "state": "NY",
            "postal_code": "141741404",
            "telephone_number": "716-531-5207"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "352 BRENTWOOD DR",
            "city": "YOUNGSTOWN",
            "state": "NY",
            "postal_code": "141741404",
            "telephone_number": "716-531-5207"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FUNCTIONAL NUTRITION OF WESTERN NEW YORK, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-05-22",
        "last_updated": "2018-05-22",
        "status": "A",
        "authorized_official_last_name": "MILLER",
        "authorized_official_first_name": "ELIZABETH",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "OWNER/REGISTERED DIETITIAN",
        "authorized_official_telephone_number": "716-531-5207",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "MS, RDN, CDN"
    },
    "taxonomies": [
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Creative Partners in Physical Therapy and Speech Language Pathology
• Michele L Destino
• Michelle Deutschman
• Krista Diez, LPN
• Andrea Rose Downie, RNFA RN FIRST ASSIST
• Serena Grainge, EMT-B
• Mark Kenneth Herbst, MS,CCC/SLP
• Laurie Ann Hewitt, RPH
• Amanda Jacobs
• Colleen Mary Johnson, LMSW, CSW

• All providers in Youngstown, NY
• Health Service Clinic/Center in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 2018; 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.