Provider Demographics
NPI:1659963742
Name:AK NUTRITION AND WELLNESS LLC
Entity Type:Organization
Organization Name:AK NUTRITION AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:KHESIN
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:551-223-0734
Mailing Address - Street 1:8100 RIVER RD APT 103
Mailing Address - Street 2:
Mailing Address - City:NORTH BERGEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07047-7205
Mailing Address - Country:US
Mailing Address - Phone:551-223-0734
Mailing Address - Fax:
Practice Address - Street 1:8100 RIVER RD APT 103
Practice Address - Street 2:
Practice Address - City:NORTH BERGEN
Practice Address - State:NJ
Practice Address - Zip Code:07047-7205
Practice Address - Country:US
Practice Address - Phone:551-223-0734
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-09
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty