Provider Demographics
NPI:1487044673
Name:COMFORT NUTRITION SERVICES LLC
Entity Type:Organization
Organization Name:COMFORT NUTRITION SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ADEKEMI
Authorized Official - Middle Name:
Authorized Official - Last Name:ADEJARE
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:856-625-6607
Mailing Address - Street 1:397 BRIDGETON PIKE
Mailing Address - Street 2:
Mailing Address - City:MANTUA
Mailing Address - State:NJ
Mailing Address - Zip Code:08051-1925
Mailing Address - Country:US
Mailing Address - Phone:856-625-6607
Mailing Address - Fax:
Practice Address - Street 1:397 BRIDGETON PIKE
Practice Address - Street 2:
Practice Address - City:MANTUA
Practice Address - State:NJ
Practice Address - Zip Code:08051-1925
Practice Address - Country:US
Practice Address - Phone:856-625-6607
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-27
Last Update Date:2015-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ945345133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty