Healthcare Provider Details

I. General information

NPI: 1558097238
Provider Name (Legal Business Name): NUTRITION CONSULTANTS OF NJ, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2022
Last Update Date: 08/03/2022
Certification Date: 08/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

449 MAIN ST
LODI NJ
07644-1818
US

IV. Provider business mailing address

8 STRATFORD CT
WARREN NJ
07059-5573
US

V. Phone/Fax

Practice location:
  • Phone: 973-517-5903
  • Fax:
Mailing address:
  • Phone: 973-517-5903
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code133VN1201X
TaxonomyObesity and Weight Management Nutrition Registered Dietitian
License Number
License Number State

VIII. Authorized Official

Name: MRS. JACQUELINE GOMES SGHERZA
Title or Position: OWNER
Credential: RDN, MBA
Phone: 973-517-5903