Provider Demographics
NPI:1750823985
Name:FUNCTIONAL NUTRITION PARTNERS
Entity Type:Organization
Organization Name:FUNCTIONAL NUTRITION PARTNERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ROMILLY
Authorized Official - Middle Name:
Authorized Official - Last Name:HODGES
Authorized Official - Suffix:
Authorized Official - Credentials:MS CNS CN
Authorized Official - Phone:973-307-0041
Mailing Address - Street 1:26 ROLLING KNOLLS DR
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07748-3333
Mailing Address - Country:US
Mailing Address - Phone:973-307-0041
Mailing Address - Fax:
Practice Address - Street 1:26 ROLLING KNOLLS DR
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NJ
Practice Address - Zip Code:07748-3333
Practice Address - Country:US
Practice Address - Phone:973-307-0041
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-04
Last Update Date:2016-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1459133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, EducationGroup - Single Specialty