Healthcare Provider Details

I. General information

NPI: 1134941099
Provider Name (Legal Business Name): THS NUTRITIONAL NAVIGATORS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2024
Last Update Date: 10/30/2024
Certification Date: 10/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 HIGHLAND AVE STE G2
GLEN RIDGE NJ
07028-1522
US

IV. Provider business mailing address

123 HIGHLAND AVE STE G2
GLEN RIDGE NJ
07028-1522
US

V. Phone/Fax

Practice location:
  • Phone: 862-346-5380
  • Fax: 908-652-9230
Mailing address:
  • Phone: 862-346-5380
  • Fax: 908-652-9230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1201X
TaxonomyObesity and Weight Management Nutrition Registered Dietitian
License Number
License Number State

VIII. Authorized Official

Name: SIMEON MERTYL
Title or Position: DIRECTOR
Credential:
Phone: 862-346-5380