Provider Demographics
NPI:1386231116
Name:ENERGIZE YOUR LIFE, LLC
Entity Type:Organization
Organization Name:ENERGIZE YOUR LIFE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN NUTRITIONIST
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:D'ANGELO
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RDN
Authorized Official - Phone:732-614-0094
Mailing Address - Street 1:3 RICHMOND RD
Mailing Address - Street 2:
Mailing Address - City:MANALAPAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07726-1742
Mailing Address - Country:US
Mailing Address - Phone:732-614-0094
Mailing Address - Fax:
Practice Address - Street 1:108 MAIN ST
Practice Address - Street 2:
Practice Address - City:OCEANPORT
Practice Address - State:NJ
Practice Address - Zip Code:07757-1030
Practice Address - Country:US
Practice Address - Phone:732-786-4032
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-28
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty