Provider Demographics
NPI:1841650611
Name:NUTRITION VITALITY & CONDITIONING LLC
Entity type:Organization
Organization Name:NUTRITION VITALITY & CONDITIONING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:M
Authorized Official - Last Name:VERO
Authorized Official - Suffix:
Authorized Official - Credentials:DCN, MA, RD, CDE
Authorized Official - Phone:201-724-9646
Mailing Address - Street 1:PO BOX 581
Mailing Address - Street 2:
Mailing Address - City:MAHWAH
Mailing Address - State:NJ
Mailing Address - Zip Code:07430-0581
Mailing Address - Country:US
Mailing Address - Phone:201-724-9646
Mailing Address - Fax:201-215-0683
Practice Address - Street 1:172 BROADWAY FRNT BLDG
Practice Address - Street 2:SUITE 202
Practice Address - City:WOODCLIFF LAKE
Practice Address - State:NJ
Practice Address - Zip Code:07677-8077
Practice Address - Country:US
Practice Address - Phone:201-724-9646
Practice Address - Fax:201-215-0683
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-07
Last Update Date:2016-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ860026133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty