Provider Demographics
NPI:1578879045
Name:INTEGRATED NUTRITION THERAPY, L.L.C
Entity Type:Organization
Organization Name:INTEGRATED NUTRITION THERAPY, L.L.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MS
Authorized Official - First Name:LEAH
Authorized Official - Middle Name:
Authorized Official - Last Name:FRAZEE
Authorized Official - Suffix:
Authorized Official - Credentials:RD LDN
Authorized Official - Phone:215-432-8124
Mailing Address - Street 1:PO BOX 3206
Mailing Address - Street 2:
Mailing Address - City:MERCERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08619-0206
Mailing Address - Country:US
Mailing Address - Phone:609-642-1442
Mailing Address - Fax:609-642-1438
Practice Address - Street 1:2275 WHITEHORSE MERCERVILLE RD
Practice Address - Street 2:SUITE 5
Practice Address - City:HAMILTON
Practice Address - State:NJ
Practice Address - Zip Code:08619-2643
Practice Address - Country:US
Practice Address - Phone:609-642-1442
Practice Address - Fax:609-642-1438
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-23
Last Update Date:2010-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN004087133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty