Provider Demographics
NPI:1194284844
Name:NUTRICULTURES NUTRITION AND DIABETES CENTER LLC
Entity type:Organization
Organization Name:NUTRICULTURES NUTRITION AND DIABETES CENTER LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/CONSULTANT
Authorized Official - Prefix:
Authorized Official - First Name:MERCY
Authorized Official - Middle Name:K
Authorized Official - Last Name:EDZIAH
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RD, CDCES
Authorized Official - Phone:201-207-2158
Mailing Address - Street 1:292 BLOOMFIELD AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07042-3624
Mailing Address - Country:US
Mailing Address - Phone:201-207-2158
Mailing Address - Fax:201-604-4639
Practice Address - Street 1:292 BLOOMFIELD AVE FL 2
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-3624
Practice Address - Country:US
Practice Address - Phone:201-207-2158
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-12
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, MetabolicGroup - Single Specialty