Provider Demographics
NPI:1467739722
Name:NUTRITION FOR LIFE LIMITED LIABILITY COMPANY
Entity Type:Organization
Organization Name:NUTRITION FOR LIFE LIMITED LIABILITY COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:
Authorized Official - Last Name:GROSSANO
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:201-725-9179
Mailing Address - Street 1:446 RADCLIFFE ST
Mailing Address - Street 2:
Mailing Address - City:WYCKOFF
Mailing Address - State:NJ
Mailing Address - Zip Code:07481-3062
Mailing Address - Country:US
Mailing Address - Phone:201-725-9179
Mailing Address - Fax:
Practice Address - Street 1:446 RADCLIFFE ST
Practice Address - Street 2:
Practice Address - City:WYCKOFF
Practice Address - State:NJ
Practice Address - Zip Code:07481-3062
Practice Address - Country:US
Practice Address - Phone:201-725-9179
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-14
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL875535133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty