Provider Demographics
NPI:1639598709
Name:EAT WELL WITH GINA, LLC
Entity Type:Organization
Organization Name:EAT WELL WITH GINA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:GINA
Authorized Official - Middle Name:M
Authorized Official - Last Name:CONSALVO
Authorized Official - Suffix:
Authorized Official - Credentials:MA, RD, LDN, NCC
Authorized Official - Phone:908-827-1482
Mailing Address - Street 1:2910 GREEN POND RD
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18045-2505
Mailing Address - Country:US
Mailing Address - Phone:908-827-1482
Mailing Address - Fax:
Practice Address - Street 1:417 CATTELL ST
Practice Address - Street 2:SUITE 2R
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18042-1703
Practice Address - Country:US
Practice Address - Phone:908-827-1482
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-15
Last Update Date:2014-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN005083133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty