Provider Demographics
NPI:1891315198
Name:ROOTS INTEGRATIVE, LLC
Entity Type:Organization
Organization Name:ROOTS INTEGRATIVE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:
Authorized Official - Credentials:MPH, RDN
Authorized Official - Phone:717-817-3293
Mailing Address - Street 1:32308 PALM CT
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08648-5202
Mailing Address - Country:US
Mailing Address - Phone:717-817-3293
Mailing Address - Fax:
Practice Address - Street 1:100 HORIZON CENTER BLVD
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08691-1910
Practice Address - Country:US
Practice Address - Phone:717-817-3293
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-16
Last Update Date:2020-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty