Provider Demographics
NPI:1710596614
Name:NUTRI-WELLNESS LLC
Entity Type:Organization
Organization Name:NUTRI-WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ELENA
Authorized Official - Middle Name:
Authorized Official - Last Name:OSTROVSKY
Authorized Official - Suffix:
Authorized Official - Credentials:MSRDN
Authorized Official - Phone:908-377-4744
Mailing Address - Street 1:1200 US HIGHWAY 22 EAST
Mailing Address - Street 2:SUITE 2000
Mailing Address - City:BRIDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:08807-2943
Mailing Address - Country:US
Mailing Address - Phone:908-377-4744
Mailing Address - Fax:
Practice Address - Street 1:1200 ROUTE 22 EAST
Practice Address - Street 2:SUITE 2000
Practice Address - City:BRIDGEWATER
Practice Address - State:NJ
Practice Address - Zip Code:08807-2943
Practice Address - Country:US
Practice Address - Phone:908-377-4744
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-27
Last Update Date:2020-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ60261860Medicaid