Provider Demographics
NPI:1245820976
Name:JENNIFER MELANSON NUTRITION LLC
Entity type:Organization
Organization Name:JENNIFER MELANSON NUTRITION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:MELANSON
Authorized Official - Suffix:
Authorized Official - Credentials:MA, RDN
Authorized Official - Phone:973-200-8390
Mailing Address - Street 1:100 VALLEY RD STE 204
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07042-2200
Mailing Address - Country:US
Mailing Address - Phone:973-200-8390
Mailing Address - Fax:
Practice Address - Street 1:100 VALLEY RD STE 204
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-2200
Practice Address - Country:US
Practice Address - Phone:973-200-8390
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-26
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty