Provider Demographics
NPI:1780177956
Name:PROACTIVE NUTRITION SERVICES LLC
Entity type:Organization
Organization Name:PROACTIVE NUTRITION SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RD/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHWETA
Authorized Official - Middle Name:
Authorized Official - Last Name:RAWAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:551-666-8043
Mailing Address - Street 1:367 OSWEGO CT
Mailing Address - Street 2:
Mailing Address - City:WEST NEW YORK
Mailing Address - State:NJ
Mailing Address - Zip Code:07093-8315
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:367 OSWEGO CT
Practice Address - Street 2:
Practice Address - City:WEST NEW YORK
Practice Address - State:NJ
Practice Address - Zip Code:07093-8315
Practice Address - Country:US
Practice Address - Phone:551-666-8043
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-12
Last Update Date:2018-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty