Provider Demographics
NPI:1336531797
Name:EGGLROCK NUTRITION, LLC
Entity type:Organization
Organization Name:EGGLROCK NUTRITION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTITIONER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:L
Authorized Official - Last Name:ROKOSZ
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:908-764-9062
Mailing Address - Street 1:397 CHESTNUT ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-9429
Mailing Address - Country:US
Mailing Address - Phone:908-764-9062
Mailing Address - Fax:
Practice Address - Street 1:397 CHESTNUT ST
Practice Address - Street 2:SUITE 2
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-9429
Practice Address - Country:US
Practice Address - Phone:908-764-9062
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-23
Last Update Date:2015-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ000133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, EducationGroup - Single Specialty