Provider Demographics
NPI:1659630598
Name:COMPLETE NUTRITION & WELLNESS
Entity Type:Organization
Organization Name:COMPLETE NUTRITION & WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETICIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:SWICK
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:201-238-2720
Mailing Address - Street 1:80 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:HOBOKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07030-3572
Mailing Address - Country:US
Mailing Address - Phone:201-238-2720
Mailing Address - Fax:201-526-4684
Practice Address - Street 1:80 PARK AVE
Practice Address - Street 2:
Practice Address - City:HOBOKEN
Practice Address - State:NJ
Practice Address - Zip Code:07030-3572
Practice Address - Country:US
Practice Address - Phone:201-238-2720
Practice Address - Fax:201-526-4684
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMPLETE NUTRITION & WELLNESS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-05-13
Last Update Date:2012-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1022771174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty