Provider Demographics
NPI:1548800626
Name:TOTAL HOLISTIC NUTRITION
Entity Type:Organization
Organization Name:TOTAL HOLISTIC NUTRITION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:KAOUTARANI
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:201-450-2530
Mailing Address - Street 1:491 VAN ORDEN ST
Mailing Address - Street 2:
Mailing Address - City:SADDLE BROOK
Mailing Address - State:NJ
Mailing Address - Zip Code:07663-5236
Mailing Address - Country:US
Mailing Address - Phone:201-450-2530
Mailing Address - Fax:
Practice Address - Street 1:491 VAN ORDEN ST
Practice Address - Street 2:
Practice Address - City:SADDLE BROOK
Practice Address - State:NJ
Practice Address - Zip Code:07663-5236
Practice Address - Country:US
Practice Address - Phone:201-450-2530
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-07
Last Update Date:2020-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty