Provider Demographics
NPI:1811564388
Name:ROUND TABLE STUDIOS LLC
Entity Type:Organization
Organization Name:ROUND TABLE STUDIOS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:TARA
Authorized Official - Middle Name:G
Authorized Official - Last Name:TOMAINO
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:908-524-7149
Mailing Address - Street 1:300 CONNELL DR STE 400
Mailing Address - Street 2:
Mailing Address - City:BERKELEY HEIGHTS
Mailing Address - State:NJ
Mailing Address - Zip Code:07922-2781
Mailing Address - Country:US
Mailing Address - Phone:908-524-7149
Mailing Address - Fax:
Practice Address - Street 1:200 CONNELL DR
Practice Address - Street 2:
Practice Address - City:BERKELEY HEIGHTS
Practice Address - State:NJ
Practice Address - Zip Code:07922-2805
Practice Address - Country:US
Practice Address - Phone:908-524-7149
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-04
Last Update Date:2021-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1800XAmbulatory Health Care FacilitiesClinic/CenterCorporate Health