Provider Demographics
NPI:1669251724
Name:GOTCHA NUTRITION & WELLNESS LLC
Entity type:Organization
Organization Name:GOTCHA NUTRITION & WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN
Authorized Official - Prefix:MS
Authorized Official - First Name:TRACYLEE
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:GOTTSCHALK
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:908-230-7648
Mailing Address - Street 1:309 ORANGE RD
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07042-4451
Mailing Address - Country:US
Mailing Address - Phone:908-230-7648
Mailing Address - Fax:888-649-4924
Practice Address - Street 1:309 ORANGE RD
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-4451
Practice Address - Country:US
Practice Address - Phone:908-230-7648
Practice Address - Fax:888-649-4924
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-27
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty