Provider Demographics
NPI:1861670671
Name:SLM NUTRITION, LLC
Entity Type:Organization
Organization Name:SLM NUTRITION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NUTRITIONIST/DIETICIAN
Authorized Official - Prefix:
Authorized Official - First Name:SUSANA
Authorized Official - Middle Name:L
Authorized Official - Last Name:MENDELSON
Authorized Official - Suffix:
Authorized Official - Credentials:RD, CDE
Authorized Official - Phone:201-637-2631
Mailing Address - Street 1:PO BOX 413
Mailing Address - Street 2:
Mailing Address - City:LINCOLN PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07035-0413
Mailing Address - Country:US
Mailing Address - Phone:201-637-2631
Mailing Address - Fax:973-696-2433
Practice Address - Street 1:330 GRAND ST
Practice Address - Street 2:SUITE 100
Practice Address - City:HOBOKEN
Practice Address - State:NJ
Practice Address - Zip Code:07030-2728
Practice Address - Country:US
Practice Address - Phone:201-637-2631
Practice Address - Fax:973-696-2433
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-04
Last Update Date:2011-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ871383133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ096805Medicare PIN