Provider Demographics
NPI:1316175706
Name:THE CENTER FOR OPTIMUM HEALTH
Entity type:Organization
Organization Name:THE CENTER FOR OPTIMUM HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:FRANK
Authorized Official - Last Name:STEFANELLI
Authorized Official - Suffix:
Authorized Official - Credentials:DC,DACNB,MS
Authorized Official - Phone:973-450-1003
Mailing Address - Street 1:567 FRANKLIN AVE
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07109-1552
Mailing Address - Country:US
Mailing Address - Phone:973-450-1003
Mailing Address - Fax:973-450-5201
Practice Address - Street 1:567 FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07109-1552
Practice Address - Country:US
Practice Address - Phone:973-450-1003
Practice Address - Fax:973-450-5302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-24
Last Update Date:2009-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJT145128Medicare UPIN