Provider Demographics
NPI:1578331641
Name:BWELL NUTRITION NJ
Entity Type:Organization
Organization Name:BWELL NUTRITION NJ
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:MINTZ
Authorized Official - Suffix:
Authorized Official - Credentials:MS,RDN
Authorized Official - Phone:201-618-1705
Mailing Address - Street 1:11 KNOLLWOOD TER
Mailing Address - Street 2:
Mailing Address - City:CALDWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07006-5808
Mailing Address - Country:US
Mailing Address - Phone:201-618-1705
Mailing Address - Fax:
Practice Address - Street 1:333 BLOOMFIELD AVE
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:NJ
Practice Address - Zip Code:07006-5166
Practice Address - Country:US
Practice Address - Phone:201-618-1705
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-18
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty