Provider Demographics
NPI:1003487661
Name:THE ENLIGHTENED DIETITIAN LLC
Entity Type:Organization
Organization Name:THE ENLIGHTENED DIETITIAN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JILL
Authorized Official - Middle Name:
Authorized Official - Last Name:EKLOF
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:973-852-3773
Mailing Address - Street 1:25 HICKORY PL APT B6
Mailing Address - Street 2:
Mailing Address - City:CHATHAM
Mailing Address - State:NJ
Mailing Address - Zip Code:07928-1469
Mailing Address - Country:US
Mailing Address - Phone:973-852-3773
Mailing Address - Fax:
Practice Address - Street 1:25 HICKORY PL APT B6
Practice Address - Street 2:
Practice Address - City:CHATHAM
Practice Address - State:NJ
Practice Address - Zip Code:07928-1469
Practice Address - Country:US
Practice Address - Phone:973-852-3773
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-06
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty