Provider Demographics
NPI:1659903870
Name:ELYSA DINZES NUTRITION LLC
Entity Type:Organization
Organization Name:ELYSA DINZES NUTRITION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELYSA
Authorized Official - Middle Name:FAITH
Authorized Official - Last Name:DINZES
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:917-837-0598
Mailing Address - Street 1:76 N HILLSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039-1110
Mailing Address - Country:US
Mailing Address - Phone:917-837-0598
Mailing Address - Fax:
Practice Address - Street 1:66 W MOUNT PLEASANT AVE STE 205
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039-2930
Practice Address - Country:US
Practice Address - Phone:917-837-0598
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-05
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty