Provider Demographics
NPI:1376783316
Name:ATLANTIC COAST LIVING FIT CENTER, INC.
Entity Type:Organization
Organization Name:ATLANTIC COAST LIVING FIT CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:M
Authorized Official - Last Name:JOSEPH
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:609-677-6980
Mailing Address - Street 1:2500 ENGLISH CREEK AVE.
Mailing Address - Street 2:BLDG. 200 STE. 224
Mailing Address - City:EGG HARBOR TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08234
Mailing Address - Country:US
Mailing Address - Phone:609-677-6980
Mailing Address - Fax:609-677-6983
Practice Address - Street 1:2500 ENGLISH CREEK AVE.
Practice Address - Street 2:BLDG. 200 STE. 224
Practice Address - City:EGG HARBOR TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08234
Practice Address - Country:US
Practice Address - Phone:609-677-6980
Practice Address - Fax:609-677-6983
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ATLANTIC COAST LIVING FIT CENTER, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-03-04
Last Update Date:2009-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ777616Medicare PIN