Healthcare Provider Details

I. General information

NPI: 1558671040
Provider Name (Legal Business Name): ANCIENT WISDOM, MODERN SOLUTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2010
Last Update Date: 09/06/2023
Certification Date: 10/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

442 ROUTE 202/206 NORTH, #245
BEDMINSTER NJ
07921
US

IV. Provider business mailing address

2132 DESERT PEAK RD
LAS VEGAS NV
89134-0124
US

V. Phone/Fax

Practice location:
  • Phone: 908-358-3908
  • Fax:
Mailing address:
  • Phone: 908-358-3908
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name: VILASAVATHI VENKATACHALAM
Title or Position: PRINCIPAL
Credential:
Phone: 908-358-3908