Provider Demographics
NPI:1134947419
Name:COGNITIVE NUTRIENT THERAPY
Entity type:Organization
Organization Name:COGNITIVE NUTRIENT THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MINTZER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:919-667-4649
Mailing Address - Street 1:301 ASHVILLE AVENUE
Mailing Address - Street 2:SUITE 111
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27518
Mailing Address - Country:US
Mailing Address - Phone:984-464-0114
Mailing Address - Fax:919-932-0854
Practice Address - Street 1:301 ASHVILLE AVENUE
Practice Address - Street 2:SUITE 111
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27518
Practice Address - Country:US
Practice Address - Phone:984-464-0114
Practice Address - Fax:919-932-0854
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AHAVA HEALTHCARE, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-09-26
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty