Provider Demographics
NPI:1255687273
Name:OPTIMUM NUTRITION
Entity Type:Organization
Organization Name:OPTIMUM NUTRITION
Other - Org Name:JENNIFER MEYERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIETITIAN/CERTIFIED DIABETES EDUCAT
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:MEYERS
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RD, CDE
Authorized Official - Phone:973-535-8447
Mailing Address - Street 1:9 OXFORD DR
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039-1406
Mailing Address - Country:US
Mailing Address - Phone:973-535-8447
Mailing Address - Fax:
Practice Address - Street 1:9 OXFORD DR
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039-1406
Practice Address - Country:US
Practice Address - Phone:973-535-8447
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-27
Last Update Date:2012-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
910093133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ20Medicare PIN