Provider Demographics
NPI:1114357019
Name:CENTER FOR MEDICAL NUTRITION THERAPY LLC
Entity Type:Organization
Organization Name:CENTER FOR MEDICAL NUTRITION THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROPRIETOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:MARILYN
Authorized Official - Middle Name:R
Authorized Official - Last Name:QUINTANA
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:551-486-6604
Mailing Address - Street 1:26 BYRNE PL
Mailing Address - Street 2:
Mailing Address - City:BERGENFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07621-1002
Mailing Address - Country:US
Mailing Address - Phone:551-486-6604
Mailing Address - Fax:201-501-0543
Practice Address - Street 1:26 BYRNE PL
Practice Address - Street 2:
Practice Address - City:BERGENFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07621-1002
Practice Address - Country:US
Practice Address - Phone:551-486-6604
Practice Address - Fax:201-501-0543
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-14
Last Update Date:2015-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty