Provider Demographics
NPI:1508117300
Name:THE WHOLE-ISTIC YOU, LLC
Entity Type:Organization
Organization Name:THE WHOLE-ISTIC YOU, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RENATA
Authorized Official - Middle Name:
Authorized Official - Last Name:DUSSIAS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:908-864-4200
Mailing Address - Street 1:335 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08876-3109
Mailing Address - Country:US
Mailing Address - Phone:908-864-4200
Mailing Address - Fax:
Practice Address - Street 1:335 E MAIN ST
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08876-3109
Practice Address - Country:US
Practice Address - Phone:908-864-4200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-20
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty