Provider Demographics
NPI:1093185480
Name:LIVING PLATE LLC
Entity type:Organization
Organization Name:LIVING PLATE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JEANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:PETRUCCI
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RDN
Authorized Official - Phone:908-234-1160
Mailing Address - Street 1:22 PEAPACK RD
Mailing Address - Street 2:P.O. BOX 158
Mailing Address - City:FAR HILLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07931-2437
Mailing Address - Country:US
Mailing Address - Phone:908-234-1160
Mailing Address - Fax:
Practice Address - Street 1:22 PEAPACK RD
Practice Address - Street 2:
Practice Address - City:FAR HILLS
Practice Address - State:NJ
Practice Address - Zip Code:07931-2437
Practice Address - Country:US
Practice Address - Phone:908-234-1160
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-29
Last Update Date:2015-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty