Provider Demographics
NPI:1558671040
Name:ANCIENT WISDOM, MODERN SOLUTIONS
Entity Type:Organization
Organization Name:ANCIENT WISDOM, MODERN SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL
Authorized Official - Prefix:
Authorized Official - First Name:VILASAVATHI
Authorized Official - Middle Name:
Authorized Official - Last Name:VENKATACHALAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-358-3908
Mailing Address - Street 1:2132 DESERT PEAK RD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89134-0124
Mailing Address - Country:US
Mailing Address - Phone:908-358-3908
Mailing Address - Fax:
Practice Address - Street 1:442 ROUTE 202/206 NORTH, #245
Practice Address - Street 2:
Practice Address - City:BEDMINSTER
Practice Address - State:NJ
Practice Address - Zip Code:07921
Practice Address - Country:US
Practice Address - Phone:908-358-3908
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-18
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, EducationGroup - Single Specialty
No133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty