Provider Demographics
NPI:1619016094
Name:VERNON NUTRITION CENTER, LLC
Entity Type:Organization
Organization Name:VERNON NUTRITION CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:
Authorized Official - Last Name:PALINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:973-764-1600
Mailing Address - Street 1:529 RT 515
Mailing Address - Street 2:SUITE 201 B
Mailing Address - City:VERNON
Mailing Address - State:NJ
Mailing Address - Zip Code:07462
Mailing Address - Country:US
Mailing Address - Phone:973-764-1600
Mailing Address - Fax:973-858-0417
Practice Address - Street 1:529 RT 515
Practice Address - Street 2:SUITE 201 B
Practice Address - City:VERNON
Practice Address - State:NJ
Practice Address - Zip Code:07462
Practice Address - Country:US
Practice Address - Phone:973-764-1600
Practice Address - Fax:973-858-0417
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ925918133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ099128Medicare ID - Type UnspecifiedMEDICARE GROUP PROVIDER N