Provider Demographics
NPI:1760012082
Name:WORKSITE WELLNESS NUTRITION
Entity Type:Organization
Organization Name:WORKSITE WELLNESS NUTRITION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:LYN
Authorized Official - Last Name:HALLISSEY
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RDN, CDN
Authorized Official - Phone:201-264-2251
Mailing Address - Street 1:45 E END AVE APT 4D
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-7980
Mailing Address - Country:US
Mailing Address - Phone:201-264-2251
Mailing Address - Fax:347-348-0734
Practice Address - Street 1:7 BROOK ST
Practice Address - Street 2:
Practice Address - City:MAHWAH
Practice Address - State:NJ
Practice Address - Zip Code:07430-1103
Practice Address - Country:US
Practice Address - Phone:201-264-2251
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-26
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty