Provider Demographics
NPI:1265840060
Name:EAT WELL, LIVE BETTER LLC
Entity Type:Organization
Organization Name:EAT WELL, LIVE BETTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN
Authorized Official - Prefix:MS
Authorized Official - First Name:DINAZ
Authorized Official - Middle Name:HOMI
Authorized Official - Last Name:ITALIA
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:804-399-5060
Mailing Address - Street 1:230 KINGS HWY E
Mailing Address - Street 2:SUITE 297
Mailing Address - City:HADDONFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:08033-1907
Mailing Address - Country:US
Mailing Address - Phone:804-399-5060
Mailing Address - Fax:
Practice Address - Street 1:750 ROUTE 73 S
Practice Address - Street 2:SUITE 309A & 310A
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-4141
Practice Address - Country:US
Practice Address - Phone:804-399-5060
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-24
Last Update Date:2014-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth ServiceGroup - Single Specialty