Provider Demographics
NPI:1295816056
Name:MINDFUL EATING COMPANY LLC
Entity Type:Organization
Organization Name:MINDFUL EATING COMPANY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:KINGLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-283-1900
Mailing Address - Street 1:20 THISTLE LN
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:NJ
Mailing Address - Zip Code:07059-5564
Mailing Address - Country:US
Mailing Address - Phone:732-283-1900
Mailing Address - Fax:732-791-9566
Practice Address - Street 1:220 CENTENNIAL AVE
Practice Address - Street 2:
Practice Address - City:PISCATAWAY
Practice Address - State:NJ
Practice Address - Zip Code:08854-3940
Practice Address - Country:US
Practice Address - Phone:732-283-1900
Practice Address - Fax:732-791-9566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2014-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ=========OtherQUALCARE
=========OtherPHCS
NJ080116Medicare ID - Type Unspecified
7654551OtherAETNA
=========OtherUNITEDHEALTHCARE
=========OtherHORIZON BCBS-NJ