Healthcare Provider Details

I. General information

NPI: 1710584743
Provider Name (Legal Business Name): THE NUTRITION SISTERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2020
Last Update Date: 03/16/2021
Certification Date: 03/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

576 VALLEY BROOK AVE STE M1
LYNDHURST NJ
07071-1919
US

IV. Provider business mailing address

113 RUTHERFORD PL
NORTH ARLINGTON NJ
07031-6303
US

V. Phone/Fax

Practice location:
  • Phone: 646-389-9196
  • Fax:
Mailing address:
  • Phone: 646-389-9196
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code133VN1501X
TaxonomySports Dietetics Nutrition Registered Dietitian
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name: NATHALIA ROSA DEFIGUEIREDO
Title or Position: PARTNER/REGISTERED DIETITIAN
Credential: MS, RD
Phone: 646-389-9196