Provider Demographics
NPI:1982215836
Name:COR WELLNESS LLC
Entity Type:Organization
Organization Name:COR WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARYKATE
Authorized Official - Middle Name:E
Authorized Official - Last Name:BRANCHE
Authorized Official - Suffix:
Authorized Official - Credentials:RDN
Authorized Official - Phone:908-455-0072
Mailing Address - Street 1:101 FAIRMOUNT RD W
Mailing Address - Street 2:
Mailing Address - City:CALIFON
Mailing Address - State:NJ
Mailing Address - Zip Code:07830-3327
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:101 FAIRMOUNT RD W
Practice Address - Street 2:
Practice Address - City:CALIFON
Practice Address - State:NJ
Practice Address - Zip Code:07830-3327
Practice Address - Country:US
Practice Address - Phone:908-455-0072
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-13
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty