Provider Demographics
NPI:1336295419
Name:STORCH NUTRITIONAL MEDICINE ASSOCIATES,PA
Entity Type:Organization
Organization Name:STORCH NUTRITIONAL MEDICINE ASSOCIATES,PA
Other - Org Name:ADVANCED METABOLIC & FUNCTIONAL MEDICINE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:J
Authorized Official - Last Name:STORCH
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:973-240-5000
Mailing Address - Street 1:210 MALAPARDIS RD STE 202
Mailing Address - Street 2:
Mailing Address - City:CEDAR KNOLLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07927-1121
Mailing Address - Country:US
Mailing Address - Phone:973-765-9413
Mailing Address - Fax:973-240-5000
Practice Address - Street 1:210 MALAPARDIS RD STE 202
Practice Address - Street 2:
Practice Address - City:CEDAR KNOLLS
Practice Address - State:NJ
Practice Address - Zip Code:07927-1121
Practice Address - Country:US
Practice Address - Phone:973-240-5000
Practice Address - Fax:973-765-9366
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7886209Medicaid
NJ7886209Medicaid