Provider Demographics
NPI:1912569831
Name:THE SIMPLE DIETITIAN LLC
Entity Type:Organization
Organization Name:THE SIMPLE DIETITIAN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LYNETTE
Authorized Official - Middle Name:MARLENE
Authorized Official - Last Name:HEM-LEE
Authorized Official - Suffix:
Authorized Official - Credentials:RDN
Authorized Official - Phone:201-744-7749
Mailing Address - Street 1:509 NORTH ST STE 100
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-1633
Mailing Address - Country:US
Mailing Address - Phone:917-982-8519
Mailing Address - Fax:201-742-6304
Practice Address - Street 1:2 UNIVERSITY PLAZA
Practice Address - Street 2:SUITE 100
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601
Practice Address - Country:US
Practice Address - Phone:201-744-7749
Practice Address - Fax:201-742-6304
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-01
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty