Provider Demographics
NPI:1912596792
Name:COMPREHENSIVE MEDICAL NUTRITION SOLUTIONS
Entity Type:Organization
Organization Name:COMPREHENSIVE MEDICAL NUTRITION SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANITA
Authorized Official - Middle Name:
Authorized Official - Last Name:JALLOH
Authorized Official - Suffix:
Authorized Official - Credentials:NUTRITIONIST
Authorized Official - Phone:908-902-3910
Mailing Address - Street 1:120 FARM LN
Mailing Address - Street 2:
Mailing Address - City:BOUND BROOK
Mailing Address - State:NJ
Mailing Address - Zip Code:08805-1414
Mailing Address - Country:US
Mailing Address - Phone:908-902-3910
Mailing Address - Fax:
Practice Address - Street 1:120 FARM LN
Practice Address - Street 2:
Practice Address - City:BOUND BROOK
Practice Address - State:NJ
Practice Address - Zip Code:08805-1414
Practice Address - Country:US
Practice Address - Phone:908-902-3910
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-15
Last Update Date:2021-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty