Provider Demographics
NPI:1609098821
Name:NUTRITION 101, LLC
Entity Type:Organization
Organization Name:NUTRITION 101, LLC
Other - Org Name:KAREN GOLDBERG, RD
Other - Org Type:Other Name
Authorized Official - Title/Position:REGESTERED DIETITIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:E
Authorized Official - Last Name:GOLDBERG
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:973-628-8118
Mailing Address - Street 1:2 BAKER ST
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-4601
Mailing Address - Country:US
Mailing Address - Phone:973-628-8118
Mailing Address - Fax:
Practice Address - Street 1:100 BAUER DR
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:NJ
Practice Address - Zip Code:07436-3105
Practice Address - Country:US
Practice Address - Phone:201-651-1010
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2011-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ912625133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ373-9135Medicare UPIN
NJ7400591Medicare UPIN
NJP3623845Medicare UPIN
NJP3623838Medicare UPIN