Provider Demographics
NPI:1477989218
Name:MEDICAL NUTRITION OF NJ, LLC
Entity Type:Organization
Organization Name:MEDICAL NUTRITION OF NJ, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PERLA
Authorized Official - Middle Name:MIZRAHI
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:RDN
Authorized Official - Phone:862-257-1297
Mailing Address - Street 1:137 UNION BLVD
Mailing Address - Street 2:
Mailing Address - City:TOTOWA
Mailing Address - State:NJ
Mailing Address - Zip Code:07512
Mailing Address - Country:US
Mailing Address - Phone:862-257-1297
Mailing Address - Fax:862-257-1299
Practice Address - Street 1:137 UNION BLVD
Practice Address - Street 2:
Practice Address - City:TOTOWA
Practice Address - State:NJ
Practice Address - Zip Code:07512
Practice Address - Country:US
Practice Address - Phone:862-257-1297
Practice Address - Fax:862-257-1299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-25
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133V00000X, 133V00000X
NJ25MA07806100133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, EducationGroup - Multi-Specialty
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty