Provider Demographics
NPI:1780288688
Name:AMBITION NUTRITION LLC
Entity type:Organization
Organization Name:AMBITION NUTRITION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHANA
Authorized Official - Middle Name:H
Authorized Official - Last Name:GOLDBERG
Authorized Official - Suffix:
Authorized Official - Credentials:RDN
Authorized Official - Phone:732-730-1961
Mailing Address - Street 1:111 YESODEI CT
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-4952
Mailing Address - Country:US
Mailing Address - Phone:732-730-1961
Mailing Address - Fax:
Practice Address - Street 1:111 YESODEI CT
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-4952
Practice Address - Country:US
Practice Address - Phone:732-730-1961
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-23
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty