Provider Demographics
NPI:1245798149
Name:SHIROM SPA & WELLNESS LLC
Entity Type:Organization
Organization Name:SHIROM SPA & WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SUMBUL
Authorized Official - Middle Name:
Authorized Official - Last Name:RIZVI
Authorized Official - Suffix:
Authorized Official - Credentials:CE
Authorized Official - Phone:609-301-8664
Mailing Address - Street 1:2025 OLD TRENTON RD STE 10
Mailing Address - Street 2:
Mailing Address - City:WEST WINDSOR
Mailing Address - State:NJ
Mailing Address - Zip Code:08550-2412
Mailing Address - Country:US
Mailing Address - Phone:609-301-8664
Mailing Address - Fax:
Practice Address - Street 1:2025 OLD TRENTON RD STE 10
Practice Address - Street 2:
Practice Address - City:WEST WINDSOR
Practice Address - State:NJ
Practice Address - Zip Code:08550-2412
Practice Address - Country:US
Practice Address - Phone:609-301-8664
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-09
Last Update Date:2019-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Multi-Specialty