AQUAHAB, LP — NPI 1679718191 (Licensed & Credentialed Nutritionist, Nutrition, Education in PHILA, PA)

CMS-1500 Box 24J / 33a • NPI

1679718191

Type 2 Organization (Box 32a/33a)

HIPAA NUCC Taxonomy • CMS Code

133NN1002X

Licensed & Credentialed Nutritionist, Nutrition, Education

Box 32 Service Location & ZIP+4

3600 GRANT AVE, PHILA, PA, 19114-2630

✓ 9-Digit EDI 837 ZIP+4 (19114-2630)

Practice Phone & Referral Fax

(215) 677-0400

Fax: (215) 671-1837

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1679718191 (AQUAHAB, LP) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).

CMS Medicare Order & Referring PECOS Eligibility

Institutional Type-2 NPI facilities enroll via CMS-855A institutional provider agreements rather than individual Order & Referring PECOS.

Official CMS NPPES Credential & Practice Profile

10-Digit NPI Number	`1679718191` (NPI-2 Organization / Facility)
Provider / Legal Name	AQUAHAB, LP
Plain-English Specialty	Licensed & Credentialed Nutritionist, Nutrition, Education NUCC Code: `133NN1002X` (Nutritionist, Nutrition, Education)
Certifying / Licensing Body	State Medical / Healthcare Licensing Board & National Specialty Board
Practice Location Address	3600 GRANT AVE, PHILA, PA, 19114-2630
Practice Telephone / Fax	Tel: (215) 677-0400 \| Fax: (215) 671-1837
Administrative Mailing Address	3600 GRANT AVE, PHILA, PA, 19114-2630
Enumeration & Last Sync	Enumerated: 2008-12-12 \| CMS Record Updated: 2008-12-12
Authorized Official	DEBORAH SIEDLECKI (BILLING SUPERVISOR)

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

3600 GRANT AVE, PHILA, PA, 19114-2630

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Plain-English Taxonomy & CMS Crosswalk (133NN1002X)

What Does Taxonomy Code 133NN1002X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 133NN1002X translates to:
"Licensed & Credentialed Nutritionist, Nutrition, Education"

CMS-1500 Medicare Specialty Crosswalk: Standard HIPAA X12N 837P / CMS-1500
Certifying / Accrediting Authority: State Medical / Healthcare Licensing Board & National Specialty Board
Clinical Scope: Consult a verified Nutritionist, Nutrition, Education for specialized diagnostic evaluation, treatment planning, and continuity of care.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (AQUAHAB, LP)

Typical CPT / Diagnostic Procedures:

Comprehensive Outpatient & Inpatient Clinical Evaluation (CPT 99202–99215)
Diagnostic Workup, Laboratory Ordering & Evidence-Based Care Coordination
Preventive Screening, Patient Counseling & Multidisciplinary Referral

Common Therapeutic Classes:

Evidence-Based Specialty Pharmacotherapy & Preventive Regimens (CMS Part D Standard)

All Registered NUCC Taxonomies & State Licenses

Taxonomy Code & Plain-English Description	State License & Primary Status
`133NN1002X` — Nutritionist, Nutrition, Education Plain English: Licensed & Credentialed Nutritionist, Nutrition, Education	State: PA \| License: `DN003739` \| Primary: Secondary
`133NN1002X` — Nutritionist, Nutrition, Education Plain English: Licensed & Credentialed Nutritionist, Nutrition, Education	State: PA \| License: `DN003889` \| Primary: Secondary
`133NN1002X` — Nutritionist, Nutrition, Education Plain English: Licensed & Credentialed Nutritionist, Nutrition, Education	State: PA \| License: `DN002660` \| Primary: Yes (Primary)

Medical Billing, RCM & Hospital Credentialing Teams:

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AQUAHAB, LP (NPI #1679718191)