Provider Demographics
NPI:1437416757
Name:VALENTINE NUTRITION LLC
Entity Type:Organization
Organization Name:VALENTINE NUTRITION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:VALENTINE
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:862-703-9232
Mailing Address - Street 1:1225 MCBRIDE AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WOODLAND PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07424-3812
Mailing Address - Country:US
Mailing Address - Phone:862-703-9232
Mailing Address - Fax:973-629-5757
Practice Address - Street 1:1225 MCBRIDE AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:WOODLAND PARK
Practice Address - State:NJ
Practice Address - Zip Code:07424-3812
Practice Address - Country:US
Practice Address - Phone:862-703-9232
Practice Address - Fax:973-629-5757
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-12
Last Update Date:2012-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1044070133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty