Provider Demographics
NPI:1710496955
Name:NUTRITION SPECIALISTS OF NEW JERSEY
Entity Type:Organization
Organization Name:NUTRITION SPECIALISTS OF NEW JERSEY
Other - Org Name:NUTRITION SPECIALISTS OF NEW JERSEY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS OWNER, CEO
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:KRAVITZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-589-2547
Mailing Address - Street 1:12 CHRISTIE LN
Mailing Address - Street 2:
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-3188
Mailing Address - Country:US
Mailing Address - Phone:732-589-2547
Mailing Address - Fax:
Practice Address - Street 1:12 CHRISTIE LN
Practice Address - Street 2:
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-3188
Practice Address - Country:US
Practice Address - Phone:732-589-2547
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty